Gastritis; It is an inflammation or damage to the covering (called mucosa) that covers the stomach surface, depending on various factors. Depending on the inflammatory reaction that develops in the stomach, mucous membranes and its lower layers, it cannot perform its function adequately and various complaints about the digestive function occur. The symptoms related to this can be seen at a level that can severely impair the quality of life.
In the natural functioning of the stomach of a healthy individual, acid secretion occurs with the intake of food. Hydrochloric (Hcl) acid plays an extremely active role in the breakdown of nutrients. As the secreted acid breaks down food, it can be harmful to the lining of the stomach. In order to be protected from this harmful effect, the stomach is covered with a protective layer covering the surface and barrier integrity is formed. In this way, acidic or harmful substances taken orally or the stomach’s own acid secretion cannot reach and damage the stomach lining itself and its lower layers, and the organ continues to function in a healthy way. If there is damage to the protective layer, excess acid secretion or any deterioration in the stomach lining due to different factors, this may cause gastritis and related complaints.
Are there different causes and courses of gastritis?
Gastritis is defined by time of occurrence and factors. While gastritis that develops suddenly or in a short time is called acute gastritis; Gastritis that occurs in the long term and causes mucous inflammation to continue with a vicious circle despite treatment is called chronic gastritis.
GASTRITIS AND GASTROPATHY CLASSIFICATION
Gastritis:
We can list the most common gastritis according to factors rather than acute or chronic gastritis.
1. Chronic nonspecific (Helicobacter pylori – stomach microbe- (+) diffuse antral gastritis, multifocal atrophic gastritis, diffuse corpus atrophic gastritis)
2. Infectious (viral, bacterial, fungal, parasitic)
3.Granulomatous (Crohn’s disease -Inflammatory bowel disease-, sarcoidosis, foreign body, infection, with tumor)
4. Different forms (collagenous, eosinophilic, lymphocytic)
5. Others (gastritis cystica profunda, Graft-versus-host disease- post-transplant tissue rejection-
GASTROPATES
Gastropathies: We can give examples of inflammatory pathologies that occur due to the effects of damaging the gastric mucosa.
1. Reactive (erosive) gastritis: Aspirin, alcohol, cocaine, stress (stresses related to hospitalization in intensive care unit, burns, previous head or abdomen operations), radiation (cancer radiation therapy), bile reflux (gallbladder operations and stomach operations) biliary leakage into the stomach due to leakage of bile into the stomach), ischemia (circulatory failures due to heart failure or shock due to insufficient blood flow to the stomach), bezoar (foreign body in the stomach), hiatal hernia (stomach hernia), congestive conditions (blood pooling due to liver cirrhosis or portal hypertension), nasogastric (injuries to the gastric mucosa due to nasal-stomach tube placement, etc.,
2. Hyperplastic gastritis:
Menetrier’s disease and hypersecretory hyperplastic gastropathy
Zollinger-Ellison Syndrome (common stomach and duodenal ulcers and gastritis development due to excessive gestrin hormone secretion due to gastrinoma tumors located in the pancreas)
Acute and chronic gastritis differ according to their causes.
ACUTE GASTRITIS
acute gastritis; are acute inflammatory pathologies of the gastric mucosa. In acute inflammation, mainly neutrophil cells line the mucosa. Acute gastritis can be classified as erosive gastritis in the absence of erosion and non-erosive gastritis (without superficial damage) according to the presence of superficial erosion of the mucosa (which can be compared to soil erosion). In addition, they can be classified by pangastritis definitions according to the localization of the stomach such as fundus (initial part-, corpus – body part-, antrum – outlet part-) or according to the involvement of the whole stomach.
Let’s give examples of the most common factors that cause acute gastritis.
NSAID (non-steroidal-anti-inflammatory drugs-ibuprofen, naproxen, indometacin, diclofenac, etoxicam, dexketoprofen, flurbiprofen) etc.), aspirin-baby aspirin, intestinal soluble aspirin),
Alcoholic beverages (vodka, raki, gin and whiskey)
Bacterial infections: Helicobacter pylori-stomach microbe-, H. heilmanii, streptokous, staphylococcus, proteus, clostridia species, Eschericia coli
Tuberculosis (rare)
- Secondary syphilis (rare)
- Cytonegalovirus (CMV)
- Fungal causes: Candida albicans, Histoplasmosis
- Chemical agents and irritant drugs
- Shock (hypovolemic, cardiogenic, septic)
- Poor hygiene, smoking, uremia- kidney failure.
- Uncommon types of acute gastritis:
Suppurative gastritis (felgmanous gastritis) . It occurs when a local (regional) or spreading infection spreads to a part or all of the gastric mucosa. Serious and occasionally
Clinical conditions that threaten the disease can be seen.
Emphysematous gastritis: It is a serious clinical condition, as in suppurative gastritis. It occurs due to gas-producing bacteria.
Let us briefly explain some definitions used in acute gastritis.
Acute erosive gastritis: Erosion is a condition that occurs due to superficial damage to the gastric mucosa for various reasons. It can be compared to soil erosion. The more widespread the erosions, the more the patient’s complaints. It may occur most frequently due to the use of aspirin, NSAID drugs and heavy alcohol use, acidic or alkaline substances.
Acute hemorrhagic gastritis: The appearance of hemorrhage (bleeding) occurs when the factors that cause acute erosive gastritis reach a more serious form. Sometimes these bleedings can turn into serious bleeding. Hematemesis (red or coffee-ground bleeding from the mouth) and/or melena (scary, foul-smelling black bleeding from the anus), hematochezia (excessive red bleeding from the rectum) may occur.
Acute stress gastritis: Although the formation of this form of gastritis is often thought to occur due to anxiety (sadness, distress, irritability), the stress meant in this form of gastritis is due to the shock of the body, burns, operations, kidney failure, central nervous system (head) injuries. It is a gastritis condition that develops due to stress that occurs in conditions such as being in conditions of respiratory failure, being connected to breathing devices due to respiratory failure, (putting a tube into the trachea (intubation) etc. Ulcer development may occur. It may cause serious bleeding.
CHRONIC GASTRITIS
Chronic (permanent) gastritis is the chronic inflammation of the gastric mucosa that occurs due to many reasons. Since this inflammation (inflammation) is in different degrees for different reasons, they cause different complaints in patients.
In general, we can divide the causes of chronic gastritis into two.
A-) Those due to infections,
B-) Non-infectious (non-infectious) causes.
C-) Unexplained gastritis.
A-) Helicobacter pylori (stomach microbe), Helicobacter Helimani, mucobacteriosis (Tuberculosis, etc. factors), histoplasmosis, mucormycosis, parasitic infections (strongiloides species, Schistosomiasis, difilobotrium latum), viral infections (CMV-cytomegalovirus, etc.) simple
B-) Autoimmune gastritis- pernicious anemia- vitamin B12 deficiency, chemical gastropathies
(Aspirin, NSAID use, chronic bile reflux (excessive leakage of bile into the stomach-due to gallbladder operations and/or gastric operations), uremia, chronic non-infectious granulomatous gastritis (Crohn’s disease, Sarcoidosis, Wegener’s granulomatosis, foreign body irritation, cocaine use) , vasculitis, plasma cell gastritis) , eosinophilic granuloma, allergic granuloma, gastric lymphoma), eosinophilic gastritis, lymphocytic gastritis, radiation-induced gastritis due to ischemic pathologies, graft versus host disease-transplantation-related gastritis.
How Does Gastritis Develop?
The development of gastritis basically occurs through three mechanisms. Maintaining a functional stomach in healthy persons; It depends on the existence of a solid protective barrier covering the stomach wall, a balanced acid secretion and a physiologically healthy stomach tissue. Gastritis can occur by the following mechanisms:
Disruption of the Gastric Protective Barrier
The deterioration of the protective barrier can occur with Hp, as well as with long-term use of aspirin and NSAIDs, or with many reasons such as chronic uremic diseases, Crohn’s disease. Among these factors, the most frequently encountered Hp infection is.
Increase in Gastric Acid Secretion
Stress and smoking are among the most common reasons that increase acid secretion after Hp. For these reasons, excessive acid secretion may cause deterioration of the integrity of the gastric mucosa and decrease in the protective barrier. However, it is not possible to argue that sadness, distress, haste, smoking alone are the cause of gastritis.
Weakening of Stomach Tissue
Insufficient blood supply to the stomach may be impaired for acute or chronic reasons. Infectious, hypovolemic or cardiogenic acute pathologies associated with disruption of the blood supply to the stomach reveals ischemic gastropathies. Atherosclerosis-, chronic circulatory disorders such as vasculitis or acute or chronic problems that disrupt the blood supply of the stomach during abdominal operations can also cause gastritis. As this process progresses, there is functional loss in gastritis due to the deterioration of the integrity of the gastric mucosa. There are different degrees of symptoms.
Helicobacter pylori (Hp) – stomach microbe- how does it cause gastritis?
The detection of Hp causing gastritis revealed a very important revolution (1983) in gastroenterology. Hp, which is usually transmitted from the community in childhood, settles under the mucous membrane, especially in the stomach. I enter the layers of the stomach lining
ez. This is why our body often fails when it attacks to eliminate this bacterium. It activates many cells of the body such as lymphocytes, macrophages, polymorphous nuclei leukocytes for the elimination of Hp. Special proteins called cytokines secreted from these cells (IL (interleukin)-8, IL -6, IL-10, TNF- alpha (tumor necrosis factor alpha)) cannot destroy this bacterium because it hides under the mucosa. damage to the stomach lining. Therefore, chronic inflammation that occurs in a vicious circle creates gastritis. It is the stomach hormone that secretes Hcl (stomach acid) called gastrin. Gastrin, which is normally secreted when the food comes into the stomach, provides the release of HCl. In the presence of Hp, exaggerated Hcl in food intake and gastrin release This excessive secretion causes chronic inflammation to continue and intensify.In addition, excessive acid damages the stomach lining and duodenum.It can cause stomach and duodenal ulcers, stomach cancer, MALT-lymphoma development.
Chronic atrophic (weakening, thinning of the stomach lining) gastritis due to Hp and Hp
As a result, intestinal metaplasia (small intestinal lining instead of stomach lining) may occur. Intestinal metaplasia is divided into types as Type I-II-III. Type-II and Type-III are associated with gastric cancer. It must be followed. Although there is no high rate of conversion to gastric cancer, its evaluation and follow-up is important.
What are the Symptoms of Gastritis?
Some symptoms and complaints occur in people with gastritis. These symptoms may vary depending on the underlying cause, as well as depending on acute and chronic pathologies. It can be faint or very severe. These complaints are not only encountered in gastritis. Acute-chronic), pancreatic cancers, colon cancers, aortic vascular diseases etc. Therefore, these complaints are not specific for gastritis.
nausea, vomiting
indigestion-dyspepsia-
burping-aerophagia-
Feeling of gas in the abdomen, bloating,
Burning or burning sensation in the abdomen or chest
Stomach ache
Vomiting black, coffee grounds or bloody – hematemesis,
Black, slimy, foul-smelling stool – melena-,
Red bloody stool-hematochezia-,
Feeling of fullness after a small amount of food intake
early satiety
Anorexia
weight loss
As mentioned above, many complaints may or may not be related to gastritis. These symptoms, which are thought to be gastritis, can be confused with diseases of many organs such as the heart, gall bladder, duodenum, pancreas, large intestine, main artery, liver. These complaints may be related to non-serious problems or may be confused with life-threatening pathologies of cardiovascular diseases. These complaints, which are often tried to be dismissed by the definition of gas compression among the public, are complaints that should be carefully evaluated because they can be confused with many diseases.
How is gastritis diagnosed?
The diagnosis of gastritis is made by gastroscopy and the evaluation of tissue biopsy samples taken at this time by the pathologist. It is suspected by listening to the complaints, but diagnosis without tissue diagnosis causes misdiagnosis. Ultrasonography is not sufficient to diagnose gastritis. Gastritis cannot be diagnosed by palpation based on symptoms alone. It should be noted that gastritis can be confused with many of the diseases I mentioned above, and that there may be confusion with similar findings. The gastroenterologist’s assessment is extensive.
What is done in the treatment?
The basic approach in the treatment of gastritis is to return the mechanisms that cause gastritis to physiological limits. However, it may be necessary to apply specific treatment methods for the disease determined depending on various underlying diseases. Appropriate treatment is planned by evaluating the patient’s disease history, physical examination, various imaging methods, and biopsies taken through endoscopy.
The most preferred approach to gastritis is regulation of gastric acid secretion. Various drug treatments such as antacids and/or proton pump inhibitors are used for this purpose. In the same way, various changes in daily living activities are suggested to the patients and nutrition programs are arranged.
If it is determined that the cause of gastritis is H. pylori infection; For this, triple or quadruple drug therapy containing three or four antibiotics can be applied for a few weeks. In the control examinations performed at the end of the treatment, it is aimed to completely destroy the bacteria.
In cases of gastritis due to drug use, anti-inf
The use of inflammatory drugs should be terminated or the necessity of their use should be evaluated and regulated. In this respect, it is very important that patients do not use drugs by their own decision without the supervision of a doctor. Irregular use of aspirin where it is not needed is extremely inconvenient. Severe gastritis, ulcer formation and ulcer-related bleeding may occur in the use of baby aspirin and intestinal soluble aspirin.
In gastritis due to special causes such as autoimmune diseases or inflammatory bowel diseases, treatment for the underlying disease is applied.
What Complications Can Develop Due to Gastritis?
In the case of acute and chronic gastritis, various complications may develop in patients who do not receive adequate and effective treatment in the early or long term. These complications not only exacerbate the existing disease picture, but may also result in more severe diseases that can be life-threatening. The complications of gastritis can be summarized as follows:
Ulcer: Depending on the underlying cause, ulcers can be seen in the stomach wall or duodenum. Depending on the anatomical region where the ulcer occurs and the severity of the ulcer; The gastrointestinal wall may be perforated, serious bleeding may occur, or various complications such as intestinal obstruction to ulcers may develop.
Gastric bleeding: As a result of damage or ulceration of the stomach tissue, bleeding from the stomach or duodenum, ranging from mild to severe, and sometimes life-threatening, may occur.
Gastric lymphoma: Especially with H. pylori infection; As a result of the cancerous cells of the immune system in the stomach tissue over time, gastric lymphoma (MALToma) may develop in the gastric mucosa-associated lymphatic tissue (MALT). With the eradication of HP, very successful results can be achieved.
Gastric cancer: When chronic gastritis caused by H. pylori infection is not treated, tumors may develop in the stomach tissue in the long term and may lead to gastric cancer. It is stated that the risk of going to gastric cancer increases approximately 15 times. For this reason, it is not correct to suggest that people with Hp infection will mostly get stomach cancer. It has been reported that in studies conducted to date, it has been determined that the elimination (eradication) of Hp with treatment reduces the risk of gastric cancer development. For this reason, if Hp is present in the children of people whose parents have gastric cancer, its eradication is extremely important. Individuals with Hp positivity should receive eradication treatment. Dual antibiotic treatments (triple drug use-Proton pump inhibitor + clarithromycin + amoxicillin) were abandoned due to the development of resistance. Not used. Practices of physicians who still use it cause the emergence of resistant Hp strains.