Gastritis

Mr. K is 40 years of age, and recently experienced a digestive disturbance and felt pain at the epigastrium, or upper central region of the abdomen, after overeating. He also sometimes presented with such symptoms as vomiting or heart burn.

He therefore visited a local clinic. Through an interview with Mr. K, the physician recognized the symptoms and performed an abdominal examination.

This was followed by a gastric X-ray, where it was found that Mr. K had no serious problems such as an ulcer or tumor but was diagnosed with gastritis. Mr. K was therefore recommended to take medication. Thereafter, the symptoms were improved but recurred over time. Mr. K therefore visited me for further evaluation and treatment. On examination, there were no abnormal findings.

During a gastroduodenofibroscopy, however, inflammation of the gastric mucosa, or the mucus membrane of the stomach, was found. He also presented with findings of gastric atropy where the gastric mucosa was thinned. This led to a diagnosis of chronic gastritis. 

Then, Mr. K was recommended to diet and exercise. This was accompanied by the prescription of some drugs. Gastritis is mainly divided into acute gastritis and chronic.

Most cases of acute gastritis occur because of factors such as severe trauma, surgery, infection or shock. Such drugs as aspirin, anti-inflammatory analgesic drugs and alcohol are also linked to its occurrence. Patients with acute gastritis present with such symptoms as abdominal pain, digestive disorder and heart burn.

There are some cases of acute gastritis in which severe bleeding is present. A diagnosis of acute gastritis is routinely made by endoscopy.

For the treatment of stress-induced acute gastritis, medication is required. It is also important to treat underlying diseases. Drug-induced iatrogenic gastritis is easily treated within several days once the causative substance is discontinued. Chronic gastritis is divided into types A and B according to the distribution of inflammation.

Type A chronic gastritis is distributed in the upper 1/2 of the stomach, the fundus and the body of the stomach, and its incidence is relatively lower than that of Type B. In some cases, it causes vitamin B12 absorption deficiency and this may lead to the occurrence of pernicious anemia.

On the other hand, in the case of Type B chronic gastritis, the inflammation is evenly distributed in the antrum of the stomach, the lower 1/2 of the stomach. Its incidence is relatively higher than that of Type A chronic gastritis.

The incidence of Type B chronic gastritis increases with age. It has been reported that Type B chronic gastritis is associated with infections of Helicobacter pylori.

These infections are prevalently seen around the world. Their prevalence is 70%-80% in developing countries including Korea and this corresponds to a much higher value as compared with the developed countries.

Once infected with this bacterial strain, most of the affected individuals may present with chronic gastritis due to a presence of it within the gastric mucosa for life.

Besides, it has also been reported that the chronic gastritis due to this bacterial strain is closely associated with the occurrence of gastrointestinal diseases such as duodenal ulcer, gastric ulcer and stomach cancer.

These gastrointestinal diseases do not occur in all the affected individuals who are infected with H. pylori, although only some of them are afflicted with such diseases. But this remains obscure.

Infections of H. pylori may be detected on histopathology with endoscopy or breath test. For the treatment of infections of H. pylori, antibiotics and antacids are concomitantly used for 1-2 weeks.

This leads to the eradication of the causative bacteria in more than 90 percent of cases. Particularly in cases of duodenal or gastric ulcers, their recurrence is markedly decreased if H pylori is eradicated.

The eradication of causative bacteria is mandatory for these cases.

Gastrointestinal diseases occur in only some cases of infections with H. pylori. It would therefore be unnecessary to eradicate the causative bacteria for the purposes of simply preventing the occurrence of stomach cancer in patients with chronic gastritis.

Chronic gastritis is a disease we can commonly encounter. It is characterized by the repeated episodes. No efforts are needed to cure chronic gastritis because its symptoms do not include abdominal pain, digestive disturbance and heart burn.

It is common for gastritis to be improved with histopathology but such symptoms as digestive disturbance, gastric pain or heart burn remain unimproved. Vitamin B12 is therefore used to treat patients with chronic gastritis who concurrently have pernicious anemia.

According to the severity of symptoms, however, patients with chronic gastritis may also be treated with antacids or any drugs that activate the natural bowel movement.

It would be more important to form the habit of regularly taking a certain amount of food than to completely cure the above symptoms with medication.

It goes without saying that we will not see symptoms improved if we take food immediately before sleep. This is because our stomach is burdened with food.
If you sit at a desk all day long in the office, you are recommended to take regular exercise for about 30 minutes to such an extent that your body sweats. For diet therapy, you are recommended to avoid spicy or salty foods.

But this may vary depending on the individuals. That is, there are no reasons to prohibit specific types of foods unless people present with any problems after actually taking them.

Psychological instability also plays a key role in the occurrence of such symptoms as digestive disturbance, heart burn or vomiting. It is therefore be important to relax.

By Kim Jae-joon 

The author is a professor of SungkyunKwan University school of medicine and doctor at Division of Gastroenterology of Samsung Medical Center. ― Ed.