Gastritis

A gastritis ( older Greek γαστρίτις, nowadays usually γαστρίτιδα, " gastritis " ), German gastritis is an inflammatory disease of the lining of the stomach.

Classification

After Timeline

Depending on the temporal course of the disease, a distinction between acute and chronic gastritis. All forms of acute gastritis can take subacute stages or become chronic.

After cause

Based on the cause ( etiology ) distinguish different subtypes of gastritis:

Type A gastritis

The type A gastritis is an autoimmune disease whose pathogenesis is not fully understood and the autoantibody the acid-producing parietal cells ( ) attack. It accounts for about 5% of gastritis. By the cell loss occurs in succession to an increase of the pH in the stomach, which constantly stimulate the gastrin. Gastrin, in turn, stimulates the neuroendocrine ECL cells of the stomach and is trophic. There will be a hyperplasia of these cells. The increased Gastrinmenge also promotes the formation of Mikrokarzinoiden. Since the destruction of the intrinsic factor -producing parietal cells may result in a decreased absorption of vitamin B12 ( cobalamin ) in the ileum according to a vitamin B12 deficiency can result (pernicious anemia).

Type B gastritis

The type B gastritis is a bacterial infection based, which is mostly caused by the corkscrew -shaped Helicobacter pylori. It is with a share of 85 %, the most common form of gastritis. After the fecal- oral ingestion, the pathogen spreads starting from the entrance to the stomach toward the pylorus. The bacterium causes chronic stomach ulcers and is blamed for favoring and development of gastric cancer.

Diagnostic gastroscopy ( gastroscopy ) with simultaneous duodenoscopy ( duodenal colonoscopy ) is strongly recommended for frequent heartburn. Can be diagnosed as the cause of the bacterium by means of urease on an extracted tissue sample ( bioptate ). For some time, there is also a Helicobacter breath test, a comfortable, non-invasive measurement method in which with high precision, the infection with Helicobacter pylori can be detected on the breath. The eradication therapy is performed with a triple combination of two antibiotics and an acid blocker (eg esomeprazole, omeprazole).

Since this form of gastritis, generally in the range of the gastric outlet ( antrum ) is located, it is also called antral gastritis.

Type C gastritis

The type C gastritis is a chemically induced gastritis. It is triggered eg by constituents of bile in bile reflux after partial resection of the stomach ( Billroth operation) or hiatal hernia. Certain nonsteroidal anti-inflammatory drugs (acetylsalicylic acid (aspirin), diclofenac ( Voltaren ), and ibuprofen) inhibit cyclooxygenase -1, and thus the formation of prostaglandin E2, which results in a reduced production of the protective mucous layer. Antibiotics can cause a type C gastritis. Type C gastritis have a share of about 10%.

When other causes are: food poisoning eg by aflatoxins, excessive alcohol consumption, smoking, contact with acids and alkalis. These factors also destroy the gastric mucosa be outsourced protective mucus layer, so that the stomach acid causes ulceration of the stomach wall.

Outside of the standard medical textbooks, two other forms are also described:

Type D gastritis

The D-type gastritis summarizes various special shapes together. This includes the gastritis by rare pathogens that Crohn's gastritis, the collagenous gastritis etc.

Type R gastritis

The Type R gastritis arises due to frequent heartburn (reflux oesophagitis ) and can lead to serious complications in the form of Barrett's esophagus after themselves.

Endoscopic / histological

On the basis of endoscopic examination and histological criteria is divided into erythematous, exudative, erosive, hemorrhagic, granulomatous and atrophic gastritis.

Symptoms

Frequently in acute gastritis consist abdominal pain, which manifest themselves as a feeling of pressure in the stomach or upper abdominal pain. However, the abdominal pain that occur can be misinterpreted in certain circumstances and then not properly diagnosed. Because the pain can be perceived behind the sternum, there is an overlap with the symptoms of other diseases, such as the heart. Typical are pain, which initially will be better after eating, and then return to the old ferocity. Other signs include melena, hematemesis and anemia caused by bleeding from the diseased gastric mucosa. Non-specific symptoms such as loss of appetite, diarrhea, nausea, dark - aqueous and vomiting may also be gastritis - especially the chronic form - accompany.

Complications

• Type A: gastric mucosal atrophy, pernicious anemia, gastric carcinoma
• Type B: It can ulcers esp. of the duodenum ( 5%) and in the stomach itself ( 1%) occur, the risk for the development of gastric cancer is increased ( 1:3000 ), as it can lead to the occurrence of so-called Malt Omen ( B-cell lymphoma of mucosa associated lymphatic tissue) come with a risk of 1:40000. In some cases there is also a chronic idiopathic urticaria and idiopathic thrombocytopenic purpura.
• Type C: this focuses on the stomach bleeding and ulcers.

Therapy

The treatment of the Type A gastritis is dependent on the severity of the inflammation. It is preferred to the formation of gastric acid -blocking proton pump inhibitors, but also acid-neutralizing antacids and acid- blocking also H2 antihistamines ( ranitidine ) was administered. Frequently a lifelong substitution of vitamin B12 is required. Regular gastroscopic controls because of the possible etiology of cancer are necessary.

The treatment of type B gastritis is the eradication of Helicobacter pylori as described above. Triple Therapy of two antibiotics and a proton pump inhibitor is optionally for seven days, thereby obtaining an Eradikationsquote of over 90% is achieved. The best results shows the combination of clarithromycin, amoxicillin and proton pump inhibitor (French scheme). After six to eight weeks of therapy success will be checked against a gastroscopy or the HP breath test. In development is a vaccine against Helicobacter pylori.

In type C gastritis removing the cause, ie the absence of ingesting harmful noxious substances is important. Again, the use of acid blockers is indicated as adjuvant. With an intake of nonsteroidal antiinflammatory drugs associated long-term treatment can not be avoided, a separate gastric protection with ranitidine or a proton pump inhibitor is an urgent need ( eg omeprazole ).

Dissemination

A survey conducted by the Robert Koch Institute in 2009 found a proportion of 20.5 % of adults in Germany, which by his own account before a medically diagnosed gastritis or duodenitis had ( women 23.3 %, men 17.5 %). 4.1% were (also) affected in the last 12 months (5.2 % of women and 3.0% of men). At the age under 65 years, women were significantly more affected than men.