GASTRITIS

Gastritis

1. Definition: Inflammation of the gastric mucosa leading to damage of the gastric glands.
2. Types:
   • Acute gastritis: Sudden onset, usually due to NSAIDs, alcohol, or infections.
   • Chronic gastritis: Prolonged inflammation, often due to H. pylori infection.

Acute GASTRITIS

1. Definition: Inflammation of the gastric mucosa that lasts for a short duration.
2. Types:
   1. Erosive gastritis: Inflammation of the gastric mucosa with erosion of the epithelial lining.
   2. Non-erosive gastritis: Inflammation of the gastric mucosa without erosion of the epithelial lining.
3. Causes:
   1. Infections (H. pylori, viral, bacterial)
   2. Stress (physical, emotional)
   3. Medications (NSAIDs, aspirin, steroids)
   4. Alcohol consumption
   5. Trauma (physical, iatrogenic)
4. Clinical Features:
   1. Abdominal pain (upper, epigastric)
   2. Nausea and vomiting
   3. Loss of appetite
   4. Weight loss
   5. Malaise
5. Investigations:
   1. Upper GI endoscopy
   2. Biopsy
   3. H. pylori testing
   4. Blood tests (complete blood count, liver function tests)
6. Complications:
   1. Gastrointestinal bleeding
   2. Perforation
   3. Gastric outlet obstruction
   4. Sepsis
7. Management:
   1. Rest and hydration
   2. Antacids or histamine-2 receptor antagonists
   3. Antibiotics for H. pylori infection
   4. Medications to prevent stress-induced gastritis
8. Treatment:
   1. Antacids or histamine-2 receptor antagonists
   2. Antibiotics for H. pylori infection
   3. Medications to prevent stress-induced gastritis

Chronic GASTRITIS

1. Definition: Inflammation of the gastric mucosa that lasts for a long duration.
2. Types:
   1. Atrophic gastritis: Inflammation of the gastric mucosa with atrophy of the gastric glands.
   2. Hypertrophic gastritis: Inflammation of the gastric mucosa with hypertrophy of the gastric glands.
   3. Erosive gastritis: Inflammation of the gastric mucosa with erosion of the epithelial lining.
3. Causes:
   1. H. pylori infection
   2. Autoimmune disorders (e.g., pernicious anemia)
   3. Chronic NSAID use
   4. Chronic stress
   5. Gastric cancer
4. Clinical Features:
   1. Abdominal pain (upper, epigastric)
   2. Nausea and vomiting
   3. Loss of appetite
   4. Weight loss
   5. Malaise
5. Investigations:
   1. Upper GI endoscopy
   2. Biopsy
   3. H. pylori testing
   4. Blood tests (complete blood count, liver function tests)
6. Complications:
   1. Gastrointestinal bleeding
   2. Perforation
   3. Gastric outlet obstruction
   4. Sepsis
   5. Gastric cancer
7. Management:
   1. Antibiotics for H. pylori infection
   2. Medications to reduce stomach acid
   3. Medications to prevent gastric cancer
   4. Dietary modifications
8. Treatment:
   1. Antibiotics for H. pylori infection
   2. Medications to reduce stomach acid
   3. Medications to prevent gastric cancer

Homoeopathic Therapeutic Medicines

1. Nux vomica: Indicated for gastritis with nausea and vomiting.
2. Pulsatilla: Indicated for gastritis with bloating and gas.
3. Lycopodium: Indicated for gastritis with abdominal pain and weight loss.
4. Phosphorus: Indicated for gastritis with nausea and vomiting.
5. Argentum nitricum: Indicated for gastritis with bloating and gas.

Important Key Points

1. Pathology: Inflammation of the gastric mucosa leads to tissue damage and loss of function.
2. Types: Acute and chronic gastritis can be classified based on the duration of the inflammation.
3. Causes: Infections, stress, medications, and trauma are common causes of gastritis.
4. Clinical Features: Abdominal pain, nausea and vomiting, loss of appetite, and weight loss are common clinical features of gastritis.
5. Investigations: Upper GI endoscopy, biopsy, H. pylori testing, and blood tests are common investigations for gastritis.

Surgical Steps (if surgery is required)

1. → Endoscopy to visualize the gastric mucosa.
2. → Biopsy to obtain tissue samples.
3. → H. pylori testing to determine the presence of the bacteria.
4. → Surgery to remove the infected tissue or to repair any damage.
5. → Post-operative care to manage pain and prevent complications.

Pathophysiology

1. Role of H. pylori: Infection causes chronic inflammation, leading to atrophy and metaplasia.
2. Role of NSAIDs: Direct injury to the gastric mucosa, leading to inflammation.
3. Role of alcohol: Irritants the gastric mucosa, leading to inflammation.
4. Role of stress: Triggers the release of stress hormones, leading to gastric acid production.
5. Role of autoimmune factors: Autoimmune reactions cause inflammation and damage to the gastric mucosa.

Etiological Factors

1. H. pylori infection
2. NSAIDs
3. Alcohol
4. Stress
5. Autoimmune factors
6. Helicobacter heilmannii
7. Other infections (e.g. cytomegalovirus, Epstein-Barr virus)
8. Medications (e.g. antibiotics, antacids)
9. Radiation therapy
10. Trauma

Clinical Features

1. Epigastric pain
2. Nausea
3. Vomiting
4. Anorexia
5. Weight loss
6. Abdominal tenderness
7. Guarding
8. Rebound tenderness

Diagnostic Investigations

1. Upper endoscopy
2. Biopsy
3. H. pylori tests (e.g. urea breath test, stool antigen test)
4. Blood tests (e.g. complete blood count, liver function tests)
5. Imaging studies (e.g. X-rays, CT scans)

Endoscopic Findings

1. Acute gastritis: Erythema, edema, and erosion of the gastric mucosa.
2. Chronic gastritis: Atrophy, metaplasia, and intestinal metaplasia.
3. Gastric ulcers: Depressed areas with inflamed surrounding tissue.
4. Mucosal atrophy: Loss of gastric glandular tissue.

Complications

1. Gastric ulcers
2. Atrophic gastritis
3. Intestinal metaplasia
4. Gastric cancer
5. Malignant transformation

Homoeopathic Therapeutics

1. Arsenic album: Acute gastritis with severe pain and vomiting.
2. Carbo vegetabilis: Chronic gastritis with bloating and flatulence.
3. Ipecacuanha: Gastritis with nausea and vomiting.
4. Nux vomica: Gastritis with pain and irritability.
5. Phosphorus: Gastritis with diarrhea and abdominal cramps.
6. Pulsatilla: Gastritis with bloating and flatulence.
7. Sulphur: Gastritis with skin eruptions and itching.
8. Zincum metallicum: Gastritis with metallic taste and burning sensation.