Definition of terms
The lining of the stomach wall (gastric mucosa) is protected by a layer of mucus that effectively forms a protective barrier against stomach acid and other harmful substances. If this protective lining is weakened, the inflammatory response may lead to the gastric mucosa becoming inflamed (reddening, swelling, damage to surface lining), with the inflammation capable of spreading to deeper layers of the stomach wall. When only the surface of the stomach lining is inflamed, this is referred to as gastritis. When deeper layers of the stomach wall are affected, this is referred to as an ulcer.
Potential causes can be divided into three different categories: The majority of cases develop as a result of chemical damage (alcohol, nicotine, medications etc.). However, an inflammatory response may also be triggered by bacteria (here: Helicobacter pylori). Last but not least, gastritis and gastric ulcers can also develop as a result of autoimmune disorders that involve the formation of antibodies against components of the gastric mucosa. All of these can be enhanced by lifestyle factors such as stress, lack of exercise and an unbalanced diet.
Frequency of occurrence
Although it is difficult to make precise statements on this issue, it is certainly correct to say that this is one of the most common disorders/group of symptoms seen in gastroenterology practice, and that the majority of chronic cases of gastritis occur as a result of bacterial infections, while cases of autoimmune gastritis are rather more rare. Helicobacter pylori infections affect approximately 50% of the general population over the age of 50, while gastric ulcers affect 50 in every 100,000 people living in industrialized countries.
Gastroscopy can be used to visualize the lining of the stomach and to evaluate whether there is any damage present. Tissue sample analysis can usually provide concrete information on the nature of the damage that has already occurred as well as helping to identify underlying causal factors. Conventional x-ray imaging of the abdominal area using contrast agents no longer plays a significant role in diagnosis Additional information can however be obtained via ultrasound, CT or MRI scans. The presence of Helicobacter pylori can also be confirmed using stool or breath testing. While there are also blood tests available that can detect H. pylori antibodies, these tend to be far less informative.
Medication to reduce the amount of acid produced by the stomach is the first line of treatment, as this allows the gastric mucosa to heal naturally. This type of medication includes proton pump inhibitors (PPI) such as Omeprazole and Pantoprazole, but also includes H2-receptor antagonists such as Ranitidine. Additional measures include the avoidance of triggers such as certain types of pain medication, as well as diet modifications. In order to ensure long-term recovery, it may also be necessary to reduce the exposure to, and adverse impact of, certain stressful situations. The advent of PPIs has meant that physicians rarely ever have to resort to surgery. In patients who test positive for Helicobacter pylori infection, eradication therapy is the treatment of choice. In the majority of cases, this involves a combination of antibiotics and PPIs, to be taken for a duration of one week. A follow-up examination is then performed after a certain period of time in order to confirm that the infection has been successfully eradicated.
Most patients with gastritis do not require follow-up treatment. Patients with gastric ulcers, on the other hand, will require a follow-up examination after 4 to 6 weeks. This will ensure that the ulcer has healed completely and allow the physician to exclude the presence of cancer. Patients with chronic changes, and in particular those seen in patients with autoimmune gastritis, should attend regular follow-up examinations, which will have to include an endoscopic examination and tissue biopsy. The success of eradication therapy should be confirmed with breath tests, stool tests and, where appropriate, a gastroscopy examination.