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Thursday, October 2, 2008

Digestive Problems, More on Gastritis and IBS (Part I)

by dr.Ay

The cause of digestive problems or gastrointestinal complain can be related with local disorders (e.g: duodenum ulcer, gastritis, or etc) or caused by systemic disease (e.g: diabetes mellitus). For example stomachache, when someone comes to you with the chief complain stomachache, we may consider that the problems is from gastrointestinal tract or organ although someother organ disease can also manifest like this. The other common symptomps that patient usually have are dyspepsia, dysfagia, nausea, vomitting, gastrointestinal bleeding, diarrhea, and constipation. It needs accurate, carefull, and systematic anamnesis in order to formulate all the symptomps so that it will guide the next examinations (physical and supporting examination) more focused. This discussion is more focus on gastritis and Irritable Bowel Syndrome (IBS).


Gastritis is an inflammation of the stomach lining. While the lining of the stomach is quite strong and can withstand strong acid, drinking too much alcohol, eating spicy foods, or smoking can cause the lining to become inflamed and irritated. Depending on the cause, gastritis may persist acutely or chronically.

Gastritis Causes. Gastritis can be caused by many things such as:

  • Stress
  • eating spicy foods
  • smoking
  • prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs)
  • prolonged use of steroid treatments
  • infection with bacteria such as E. coli, Salmonella, or Helicobacter pylori
  • Fungal infection (most often in people with immunodeficiency)
  • Parasitic infection (most often by Anisakis spp. from poorly cooked seafood)
  • drinking too much alcohol
  • major surgery
  • traumatic injury or burns
  • certain diseases, such as megaloblastic (pernicious) anemia, autoimmune disorders, and chronic bile reflux
  • Certain allergens
  • Certain types of radiation
  • Eating Disorders (e.g.: bulimia)

Gastritis Symptomps. The following are the most common symptoms of gastritis. However, each individual may experience symptoms differently. Symptoms may include:

  • stomach upset or pain
  • belching
  • abdominal bleeding
  • nausea
  • vomiting
  • feeling of fullness or burning in the stomach
  • blood in vomit or stool (a sign that the stomach lining may be bleeding)

The symptoms of gastritis may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

Supporting Examination. In suspected cases, a doctor usually orders a barium meal test and gastroscopy to determine gastritis and related conditions such as peptic ulcers and gastric cancer. It is always important that the doctor reviews a patient's history regarding medications, alcohol intake, smoking, and other factors that can be associated with gastritis. In some cases, the appearance of the stomach lining seen during gastroscopy and the results of the barium meal test are reliable in determining gastritis and the cause. However, the most reliable method for determining gastritis is doing a biopsy during gastroscopy and checking for histological characteristics of gastritis and infection. For Helicobacter infection (the most common cause), one can test non-invasively with a urea breath test, stool antigen test, or blood antibody test.

If diarrhea is present also, the correct diagnosis may not be gastritis but rather gastroenteritis.

Treatment. Generally, treatment for gastritis involves antacids and other medications aimed at reducing stomach acid, relieving symptoms, and promoting the healing of the stomach lining, as acid irritates the inflamed tissue. If the gastritis is related to an illness or infection, that problem will be treated as well.

The medications that can be used include H2-blockers (famotidine, simetidine, and ranitidine), proton-pump inhibitors (omeprazole or lansoprazole), coating agents (sucralfate or misoprostol), antibiotics, and antiemetics.

In cases of infection, a doctor will most often prescribe antimicrobial drugs. Helicobacter infection typically responds well to the triple therapy protocol (consisting of two antibiotics, and a proton pump inhibitor). Regimens that work well include PCA or PCM triple therapy (PPI, Clarithromycin, Amoxicillin) or (PPI, Clarithromycin, Metronidazole). Quadruple therapy has a >90% success rate and includes PPIs, Bismuth subsalicylates, Metronidazole, and Tetracycline.

Patients are also advised to avoid foods, beverages, or medications that cause symptoms or irritate the lining of the stomach. If the gastritis is related to smoking, quitting is recommended.

Related sources:

Gastritis medications. EmedicineHealth. Practical guide to health.

Gastritis - Wikipedia, the free encyclopedia.mht

Treatment of Helicobacter pylori infection. BMJ

Digestive disorder, Gastritis. www.uVa.com

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