Causes
Acute gastritis can be triggered by many different damaging influences on the stomach lining. These include drugs such as aspirin and painkillers of the NSAID group, drugs containing cortisone, iron and potassium preparations or chemotherapy. Heavy alcohol consumption can also trigger acute gastritis.
In the case of food poisoning, bacteria that can produce toxins (e.g. staphylococci, Bacillus cereus) cause inflammation of the stomach lining. Stress on the body caused by burns, circulatory shock, operations or competitive sports can also trigger acute gastritis. The chronic forms of gastritis are divided into three types.
Type A is caused by autoimmune processes. Here, the body’s own immune defense attacks the stomach lining. The immune cells damage and destroy the gastric mucosa with subsequent inflammation.
The inflammation of the stomach mucosa of type B is caused by a bacterium called Helicobacter pylori. Helicobacter pylori is a spiral-shaped bacterium that can be found in the stomach of many people. Normally, bacteria in the stomach cannot survive because of stomach acid.
However, Helicobacter pylori has a trick to protect itself from stomach acid: This bacterium has an enzyme called urease. The enzyme urease splits urea into ammonia and carbon dioxide, creating an alkaline (basic) environment around the bacterium that protects the bacterium from stomach acid. Helicobacter pylori has flagella with which it can move through the mucous layer on the stomach lining to the cells of the stomach lining.
Helicobacter pylori nests near the cells of the stomach mucosa and damages the cells by producing toxins, which leads to inflammation. The probability of having a stomach colonized by Helicobacter pylori increases with age. However, a colonization with Helicobacter pylori does not necessarily mean that an inflammation of the stomach mucosa must occur.
Often, additional damage to the mucous membrane caused by alcohol or medication is the first step towards the onset of type B gastritis. The inflammation of the type C gastric mucosa is caused by the chemical influence of harmful substances on the stomach mucosa. First among the causes of type C gastritis are drugs that damage the stomach lining.In this context, long-term therapy with non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or diclofenac should be mentioned in particular.
However, reflux (backflow) of bile acids into the stomach can also lead to chronic inflammation of the type C gastric mucosa. Other causes of chronic gastritis can be a congestion of the mucous membrane due to portal vein hypertension or right heart failure. Less frequent special forms are, for example, Crohn’s gastritis as a concomitant disease of Crohn’s disease or eosinophilic gastritis, the cause of which is not clarified.
Acute inflammation of the stomach lining is treated by omitting the triggering substance, which means that any alcohol consumption must be stopped or drugs that damage the stomach lining should be replaced by less harmful drugs. It can be helpful in acute gastritis to avoid acid-producing foods for a certain time. Fatty foods, for example, increase the production of gastric acid.
Gastric acid counteracts the healing process and should therefore not be unnecessarily stimulated in its production. Proton pump inhibitors (PPI) are available for the medicinal therapy of acute inflammation of the stomach lining, which reduce the production of stomach acid. In layman’s terms, these drugs, which include pantoprazole and omeprazole, are referred to as “stomach protection”.
If the patient experiences severe nausea or vomiting, the nausea can be relieved by the administration of an antiemetic such as dimenhydrinate (Vomex). The chronic forms of gastritis are treated depending on the cause: Type A gastritis is often accompanied by parallel colonization with Helicobacter pylori, and therapy of the infection with this bacterium can lead to healing of some of the type A gastritis. In case of prolonged type A gastritis, the resulting vitamin B-12 deficiency must be compensated by the administration of vitamin B-12 preparations.
In addition, treatment with immunosuppression is necessary. Symptomatic type B gastritis is treated with a combination therapy of various antibiotics. In Germany, the so-called “French Triple” is used, which includes the antibiotics clarithromycin and amoxcillin and a proton pump inhibitor.
A possible further triple combination for penicillin allergy is the “Italian Triple” with Clarithromycin, Metronidazol and a proton pump inhibitor. If the triple therapy fails, a quadruple therapy with tetracycline, metronidazole, a proton pump inhibitor and a bismuth salt is used for 10 days. The success rate of the quadruple therapy is 95%. Type C gastritis triggered by the ingestion of NSAIDs is treated by discontinuing the corresponding medication. If necessary, the therapy can be supported by the administration of proton pump inhibitors.
