Gastritis

Introduction
Gastritis is an inflammation of the stomach lining. Many things can cause gastritis. Most often the cause is infection with the same bacteria -- Helicobacter pylori -- that causes stomach ulcers. An autoimmune disorder, a backup of bile into the stomach, or long term use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can also cause gastritis. In some cases, the stomach lining may be "eaten away," leading to sores (peptic ulcers) in the stomach or first part of the small intestine. Gastritis can occur suddenly (acute gastritis) or gradually (chronic gastritis). In most cases, gastritis does not permanently damage the stomach lining.

Signs and Symptoms

The most common symptoms of gastritis are stomach upset and pain. Other possible symptoms include:

Indigestion (dyspepsia) Heartburn Abdominal pain Hiccups Loss of appetite Nausea Vomiting, possibly of blood or material that looks like coffee grounds Dark stools

Causes
Gastritis can be caused by infection, irritation, autoimmune disorders (where the bodys immune system mistakenly attacks the stomach), or backflow of bile into the stomach (bile reflux). Gastritis can also be caused by a blood disorder called pernicious anemia. Infections can be caused by:

Bacteria (usually Helicobacter pylori) Virus (including herpes simplex virus) Parasite Fungus

A number of things can cause irritation, including:

Long term use of NSAIDs, such as ibuprofen (Advil, Motrin) or naproxen (Aleve)

Alcohol use Cigarette smoking Chronic vomiting Coffee and acidic beverages Too much stomach acid (such as from stress) Eating or drinking caustic or corrosive substances (such as poisons) Trauma (for example, radiation treatments or having swallowed a foreign object)

Other causes for gastritis are very rare. These include:

Systemic disease (for example, Crohn's disease) Sarcoidosis

Risk Factors

Infection with H. pylori Acquired immunodeficiency syndrome (AIDS) Any condition that requires relief from chronic pain using NSAIDS, such as chronic low back pain, fibromyalgia, or arthritis Alcoholism Cigarette smoking Older age Herpes simplex virus or cytomegalovirus Inflammatory bowel disease

Diagnosis
Several tests can be used to make a diagnosis. These include endoscopy of the stomach, where a thin tube with a light and a camera on the end is inserted down your throat into your stomach. This allows the doctor to see into your stomach and take samples (called a biopsy) from the lining if needed. The laboratory tests you may need will depend on the cause of your gastritis. A stool test may be used to check for the presence of blood, or a biopsy may be taken of the tissues of your esophagus or stomach. A breath test may detect H. pylori, or samples from your esophagus or stomach may be taken to look for this bacteria.

Prevention
Making lifestyle changes, such as avoiding the long term use of alcohol, NSAIDs, coffee, and drugs, may help prevent gastritis and its complications (such as a peptic ulcer). Reducing stress through relaxation techniques -- including yoga, tai chi, and meditation -- can also be helpful.

Treatment

Treatment of gastritis depends on the cause of the problem. Some cases of gastritis may resolve by themselves over time, or be relieved when you stop drinking alcohol, smoking cigarettes, or taking NSAIDs. You may need to change your diet, although doctors now know that a bland diet isnt required. If your gastritis is due to H. pylori infection, you will be given antibiotics.

Lifestyle
The treatment for gastritis that is caused by irritants is to stop using them. These include:

Alcohol Tobacco Acidic beverages such as coffee (both caffeinated and decaffeinated), carbonated beverages, and fruit juices with citric acid NSAIDS, such as aspirin and ibuprofen -- switch to other pain relievers (like acetaminophen)

These steps may also help:

Eat a fiber rich diet. Foods containing flavonoids, like apples, celery, cranberries (including cranberry juice), onions, garlic, and tea may stop the growth of H. pylori. Avoid high fat foods. In animal studies, high fat foods increase inflammation in the stomach lining.

Medications
If you have H. pylori, you will probably be prescribed 3 medications. "Triple therapy," including a proton pump inhibitor to reduce acid production and 2 antibiotics, is commonly used to treat H. pylori related gastritis and ulcers. Bismuth salicylate (Pepto Bismol) may be used instead of the second antibiotic. This drug, available over the counter, coats and soothes the stomach, protecting it from the damaging effects of acid. 2 drug regimens are currently being developed. Some of the same drugs are used for non-H. pylori gastritis as well as for symptoms (like indigestion) due to ulcers: Antacids -- Available over the counter, they may relieve heartburn or indigestion but will not treat an ulcer. Antacids may block medications from being absorbed and thereby decrease the medicine's effectiveness. Doctors recommend taking antacids at least 1 hour before or 2 hours after taking medications. Ask your pharmacist or doctor for more information. Antacids include:

Aluminum hydroxide (Amphojel, AlternaGEL) Magnesium hydroxide (Phillips' Milk of Magnesia) Aluminum hydroxide and magnesium hydroxide (Maalox, Mylanta) Calcium carbonate (Rolaids, Titralac, Tums) Sodium bicarbonate (Alka-Seltzer)

H2 blockers -- reduce gastric acid secretion. They include:

Cimetidine (Tagemet) Ranitidine (Zantac) Nizatidine (Axid) Famotidine (Pepcid)

Proton pump inhibitors -- decrease gastric acid production. They include:

Esomeprazole (Nexium) Lansoprazole (Prevacid) Omeprazole (Prilosec) Pantoprazole (Protonix) Rabeprazole (Aciphex)

Nutrition and Dietary Supplements

Doctors used to recommend eating bland foods with milk and only small amounts of food with each meal. Researchers now know that such a diet isnt required to treat gastritis or ulcers. Following these nutritional tips may help reduce symptoms:

Foods containing flavonoids, like apples, celery, cranberries (including cranberry juice), onions, garlic, and tea may inhibit the growth of H. pylori. Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell peppers). Eat foods high in B vitamins and calcium, such as almonds, beans, whole grains (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables. Avoid refined foods, such as white breads, pastas, and sugar. Eat lean meats, cold water fish, tofu (soy, if no allergy) or beans for protein. Use healthy oils, such as olive oil. Reduce or eliminate trans fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine. Avoid beverages that may irritate the stomach lining or increase acid production including coffee (with or without caffeine), alcohol, and carbonated beverages. Drink 6 - 8 glasses of filtered water daily. Exercise at least 30 minutes daily, 5 days a week. Identify and eliminate food allergies.

The following supplements may help with digestive health:

A multivitamin daily, containing the antioxidant vitamins A, C, E, the B vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium. Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tablespoonful oil 2 - 3 times daily -- may help decrease inflammation. Fish oil may increase the risk of bleeding. If

you take aspirin or other anticoagulants (blood thinners), talk to your doctor before taking fish oil. Probiotic supplement (containing Lactobacillus acidophilus ), 5 - 10 billion CFUs (colony forming units) a day -- Probiotics or friendly bacteria may help maintain a balance in the digestive system between good and harmful bacteria, such as H. pylori. Probiotics may help suppress H. pylori infection and may also help reduce side effects from taking antibiotics, the treatment for an H. pylori infection. Some probiotic supplements may need to be refrigerated for best results. People who have weakened immune systems or who are taking immune suppressive drugs should take probiotics only under the direction of their physician.

Herbs
Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

Cranberry (Vaccinium macrocarpon) 400 mg twice daily -- Some preliminary research suggests cranberry may inhibit H. pylori growth in the stomach. Mastic (Pistacia lentiscus) standardized extract, 1,000 - 2,000 mg daily in divided dosages -- Mastic is a traditional treatment for peptic ulcers and inhibits H. pylori in test tubes. More studies are needed to see whether it works in humans. DGL-licorice (Glycyrrhiza glabra) standardized extract, 250 - 500 mg 3 times daily, chewed either 1 hour before or 2 hours after meals -- may help protect against stomach damage from NSAIDs. Glycyrrhizin is a chemical found in licorice that causes side effects and drug interactions. DGL is deglycyrrhizinated licorice, or licorice with the glycyrrhizin removed. Peppermint (Mentha piperita) standardized, enteric coated tablet, 1 tablet 2 - 3 times daily -- may help relieve symptoms of peptic ulcer. Each tablet contains 0.2 ml peppermint oil. Be sure to use the enteric coated form to avoid heartburn.

Homeopathy
Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of gastritis symptoms (such as nausea and vomiting) based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account your constitution -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for you individually.

Pulsatilla -- for heartburn, queasiness, a bad taste in the mouth brought on by eating rich foods and fats (especially ice cream); symptoms may include vomiting partly digested

food. This remedy is most appropriate for someone whose tongue is coated with a white or yellow substance. Ipecacuahna -- for persistent and severe nausea, with or without vomiting and diarrhea, caused by an excess of rich or fatty foods. Carbo vegetabilis -- for bloating and indigestion, especially with flatulence and fatigue. Nux vomica -- for heartburn, nausea, retching without vomiting, and sour burps caused by overeating, alcohol use, or coffee drinking. This remedy is most appropriate for people who also feel irritable and sensitive to noise and light.

Acupuncture
Acupuncture may help reduce stress and improve overall digestive function.

Other Considerations
Go back to your doctor if your symptoms do not get better or get worse. Do not ignore potentially life threatening symptoms, such as vomiting blood or blood in your stool. Blood in the stool can be hard to see. The stools may simply look very dark, even black. Be sure to see your health care provider regularly, and call your doctor if there is any change in your symptoms. If you are on both antibiotics and vitamin B12, take them at different times of day. Vitamin B12 interferes with antibiotic absorption.

Pregnancy
If you are pregnant or breastfeeding, you should ask your doctor before taking any medication, including herbs.

Prognosis and Complications

Symptoms of H. pylori infection usually get better with treatment. Your doctor will likely want to see you again 4 weeks or more after stopping your drug regimen. Follow up is very important because the H. pylori bacteria may increase risk of stomach cancer. Peptic ulcers may develop when stomach acid damages the lining of the stomach or the first part of the small intestine (called the duodenum). These ulcers can usually be treated with lifestyle changes and medication.

Supporting Research
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