Inflammation of the lining of the stomach

introduction

A Inflammation of the lining of the stomach is considered by doctors gastritis designated (Greek. gaster = stomach). Inflammation of the lining of the stomach is a common condition that various causes may have. There is a acute form the gastric mucosal inflammation that acute gastritis and three types of chronic inflammation of the lining of the stomach.

Acute gastritis can be triggered, for example, by excessive alcohol or by taking painkillers such as aspirin.

The chronic type A gastritis (5% of chronic gastric mucosal infections) is caused by autoimmune processes caused that chronic type B gastritis is found in 80% of chronic inflammation cases and is caused by a bacterium called Helicobacter pylori triggered. The chronic inflammation of the gastric mucosa of type C is caused by chemical toxins, such as by the constant use of pain relievers the NSAID (Non-Steroidal Anti-Inflammatory Drugs) group such as Diclofenac or Ibuprofen. In addition to this classification of the forms of inflammation, there are even rarer special forms such as Crohn's gastritis or the eosinophilic gastritis.

Depending on the cause and type of gastric mucosal inflammation, various therapy options are available.

Symptoms

Patients with a acute gastritis complain about Loss of appetite, nausea and Vomit. Join in Pain or pressure in the upper abdomen, frequent belching and a unpleasant taste in the mouth.

A chronic inflammation of the stomach lining however, runs in many cases without symptoms. However, it is possible that patients with chronic gastritis over Loss of appetite, diffuse Abdominal pain in the upper abdomen and over Nausea or vomiting complain.

Patients with a Type A gastritis In addition to the symptoms described above, a Vitamin B-12 deficiency noticeable, since in autoimmune gastritis the parietal cells are destroyed, which are responsible for the absorption of Vitamin B12 necessary Intrinsic factor to produce. In patients with a Type B gastritis there may be an unpleasant halitosis. Patients whose Gastric mucosa severely damaged by chronic inflammation can be caused by the Vomiting fresh and / or clotted blood (so-called breaking coffee grounds or Vomiting blood) as well as through black tarry stool (Bowel movements with digested blood).

causes

A acute gastritis can be triggered by many different damaging influences on the gastric mucosa. These include drugs such as aspirin and NSAID group pain relievers, cortisone medication, Iron and potassium supplements or one chemotherapy. Also stronger Alcohol consumption can cause acute gastritis. At a Food poisoning it comes through bacteriathat can produce toxins (e.g. Staphylococci, Bacillus cereusinflammation of the lining of the stomach. More acting on the body Burn stress, one Circulatory shock, Operations or competitive sports can also trigger acute gastritis.

The chronic forms The gastric mucosal inflammations are divided into three types. Type a is through autoimmune processes caused. Here it comes to Attack of the body's immune system on the stomach lining. Through the Immune cells the gastric mucosa is damaged and destroyed subsequent inflammation.

Inflammation of the stomach lining from Type B is made by a bacterium called Helicobacter pylori triggered. Helicobacter pylori is a spiral bacteriumwhich can be found in the stomach of many people. Usually bacteria cannot survive in the stomach because of the stomach acid. Helicobacter pylori has a trick to protect itself from Stomach acid Protect: This bacterium owns an enzyme called Urease. The enzyme urease breaks down urea into ammonia and carbon dioxide and thus creates one alkaline (basic) environment the bacterium that protects the bacterium from stomach acid. Helicobacter pylori has flagella with which it can move through the mucous layer on the gastric mucosa to the cells of the gastric mucosa. Helicobacter pylori lodges near the cells of the stomach lining and damages the cells by producing toxins, which leads to inflammation. The likelihood of having a Helicobacter pylori-colonized stomach increases with age. However, a colonization with Helicobacter pylori does not necessarily mean that there is inflammation of the gastric mucosa. Often only additional damage to the mucous membrane caused by alcohol or medication leads to an outbreak Type B gastritis. The type C inflammation of the gastric mucosa is caused by the chemical influence of harmful substances on the gastric mucosa.

First of all the causes for one Type C gastritis are drugs that damage the gastric lining. Here is one above all Long-term therapy with non-steroidal anti-inflammatory drugs (NSAIDs) how Ibuprofen or Diclofenac to call. But also a Reflux (Backflow) of bile acids into the stomach can lead to chronic type C inflammation of the gastric mucosa. Other causes of chronic gastritis can be mucous membrane congestion due to portal hypertension or Right heart failure be, rarer special forms are for example the Crohn's gastritis as a concomitant disease Crohn's disease or the eosinophilic gastritis, the cause of which is not clear.

therapy

The acute inflammation of the gastric mucosa is treated by leaving out the triggering substance, which means that a any alcohol consumption must be discontinued or drugs that damage the stomach lining less harmful drugs should be replaced. It can be helpful for acute gastritis for a period of time to avoid acidic foods. Oily foods for example, let the Gastric acid production increase. The Stomach acid counteracts the healing process and should therefore not be unnecessarily stimulated in its production.

To drug therapy acute inflammation of the gastric mucosa Proton pump inhibitors (PPI) available to the production of Reduce stomach acid. In layman's terms, these drugs become who Pantoprazole and Omeprazole are called "stomach protection". Exists with the patient severe nausea or Vomit, the nausea can be caused by the gift of a Antiemetic how Dimenhydrinate (Vomex) can be improved.

The chronic forms of gastric mucosal inflammation are treated depending on the cause: The Type A gastritis often goes with a parallel settlement Helicobacter pylori At the same time, treatment of the infection with this bacterium can heal some of the type A gastritis. If type A gastritis has persisted for a long time, the resulting Vitamin B-12 deficiency through the gift of Vitamin B-12 supplements be balanced. Also needs to be treated by immunosuppression.

The symptomatic Type B gastritis is through a Combination therapy of different antibiotics treated. In Germany, the so-called "French triples“To which the antibiotics Clarithromycin and Amoxcillin and a Proton pump inhibitors belong. Another possible triple combination at Penicillin allergy is this "Italian triples " With Clarithromycin, Metronidazole and one Proton pump inhibitors. If the triple therapy fails, one comes Quadruple Therapy With Tetracycline, Metronidazole, one Proton pump inhibitors and one Bismuth salt for over 10 days. The success rate of quadruple therapy is 95%.

One caused by taking NSAIDs Type C gastritis is through the Discontinue the appropriate medication treated. If necessary, the therapy can be given by the administration of Proton pump inhibitors get supported.

diagnosis

To the Diagnosis of inflammation of the lining of the stomach the doctor will first come up with one detailed anamnesis and physical exam to get an overview of the symptoms. One way to clarify is that endoscopic gastroscopy (gastroscopy), during which the doctor can visually assess the gastric mucosa and the possibility of removing a Mucosal biopsy consists.

In acute gastritis, gastroscopy reveals reddened mucous membrane and minor bleeding, but in most cases gastroscopy is not necessary to make the diagnosis of acute gastritis. Fall talking to the doctor or doing the physical exam Alarm symptoms how Weight loss, Performance kink, difficulties swallowing, Blood in the vomit or in chair, fever or one Anemia on, should definitely be one Gastroscopy with taking biopsies and a Examination for Helicobacter pylori be performed. In gastroscopy, the location and type of mucosal damage provide an indication of the type of inflammation present.

To the Detection of Helicobacter pylori there are several options: The 13C urea breath test is used both for non-invasive screening as well as to control the success of the therapy under the antibiotic therapy used. He has one high sensitivity (over 95%). This test is given to the patient 13C-labeled urea administered in a drinkable solution. If the patient's stomach is colonized with Helicobacter pylori, the urease of the bacterium splits this urea into ammonia and also into 13C-labeled carbon dioxide. The amount of 13C-labeled carbon dioxide in the exhaled air is measured. Is the patient's stomach not colonized with Helicobacter pylori, is the Test negative and no 13C-labeled carbon dioxide was found in the exhaled air.

To test tissue samples from a biopsy for Helicobacter pylori, the CLO rapid test (Campylobacter line organism test) carried out. The tissue sample is placed in a pH-sensitive solution inserted that at Changes in pH change color. Because Helicobacter pylori is alkaline Produces ammonia, an infected tissue develops pH change and thus to a color change that shows the Helicobacter infection with great sensitivity.

Further possibilities exist in Detection of the bacterium in the stool or proof of Antibodies in the blood. The diagnostic gold standard of Helicobacter detection is microscopic assessment after making special stains that make the bacterium visible. In order to avoid false negative test results when detecting Helicobacter pylori, it is important that therapy with proton pump inhibitors is discontinued several days before the diagnosis is carried out. At the suspicion of a Type A gastritis can Auto antibodies against Parietal cells and / or the Intrinsic factor and a low vitamin B-12 concentration in the blood to be established.

forecast

The Acute gastritis prognosis is very good, since almost all acute inflammations of the gastric mucosa heal spontaneously if the harmful substance is omitted. Only in a great way rare cases can lead to acute gastritis life threatening bleeding of the gastric mucosa come. A Type A gastritis increases that Stomach cancer risk of affected patients, which is why these patients once annually for gastroscopy with biopsy should come in order to be able to determine any degeneration of the gastric mucosa at an early stage.

Patients with type B gastritis are three to four times more likely to develop ulcer disease in the stomach or small intestine. An infestation with Helicobacter pylori is also associated with an increased risk of adenocarcinoma or MALT lymphoma of the stomach. Malignant degeneration is less common in type B gastritis with a probability of 1: 1000 than in type A gastritis.

prophylaxis

One acute gastritis can be prevented by taking longer Taking pain medication or cortisone supplements in addition to Proton pump inhibitors is treated. Also one healthy and balanced diet With infrequent alcohol, coffee and nicotine consumption prevent acute gastritis. Because an acute gastritis also through excessive stress It is advisable to maintain good psychosocial health in order to prevent acute gastritis from developing. Of the Type A inflammation of the gastric mucosa cannot be prevented because it is triggered by the body's own processes and sometimes also with others Autoimmune diseases is associated.