Gastritis

Common causes:**

• Helicobacter pylori infection is the most frequent cause of chronic gastritis.
• NSAID or corticosteroid overuse.
• Excessive alcohol consumption.
• Autoimmune mechanisms (e.g., autoimmune metaplastic atrophic gastritis).
• Bile reflux, severe stress, or viral infections.

Pathophysiology:** Disruption of the mucosal barrier allows acid-mediated damage, leading to inflammation, epithelial injury, and sometimes atrophy or metaplasia.

Common symptoms:**

• Upper abdominal pain or discomfort (burning, aching).
• Nausea, vomiting, bloating, and early satiety.
• Loss of appetite.

Red-flag symptoms:**

• Hematemesis (vomiting blood) or coffee-ground emesis.
• Melena (black, tarry stools) or hematochezia.
• Unintended weight loss, severe persistent pain.
• Signs of anaemia (e.g., fatigue, pallor).

Clinical evaluation:*

• History (medication use, *H. pylori risk factors, dietary habits), physical exam.

Diagnostic tests:**

• Upper endoscopy (esophagogastroduodenoscopy) with biopsy (definitive for diagnosis and ruling out malignancy).
• H. pylori testing: urea breath test, stool antigen test, or histology.
• Blood tests: CBC (for anaemia), vitamin B12 levels (if autoimmune gastritis suspected).
• Imaging: Not primary; occasionally CT for complication assessment.

Non-pharmacological:**

• Avoid triggers (NSAIDs, alcohol, spicy/acidic foods).
• Stress reduction, dietary modifications (e.g., smaller meals).

Pharmacological:**

• Acid suppression: Proton pump inhibitors (PPIs) or H2-receptor antagonists.
• H. pylori eradication: Combination therapy (e.g., PPI plus antibiotics).
• Cytoprotective agents: Sucralfate or misoprostol (for NSAID-induced gastritis).
• Vitamin B12 supplementation (in autoimmune gastritis with pernicious anaemia).

• Peptic ulcer disease.**
• Gastrointestinal bleeding.**
• Atrophic gastritis with intestinal metaplasia (increased risk of gastric adenocarcinoma).**
• Pernicious anaemia (in autoimmune gastritis).**
• Rarely, gastric perforation (especially in severe erosive gastritis).**

Prevention:**

• Limit NSAID use; use COX-2 inhibitors or concomitant PPIs if necessary.
• H. pylori testing and eradication in high-risk populations.
• Moderate alcohol consumption, avoid smoking.

Follow-up:**

• Symptom monitoring and reassessment if unresponsive to initial therapy.
• Repeat endoscopy if concerning features (e.g., dysplasia, persistent symptoms).
• Long-term surveillance in cases of atrophic gastritis or metaplasia per guidelines.