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Gastrointestinal & Hepatic System

Gastritis

Inflammation of the gastric mucosa (stomach lining). Can be acute (sudden onset, short duration) or chronic (long-lasting).

Also known as: Stomach Inflammation

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Referral and warning signs

When to refer

Referral for Endoscopy if: Alarm features present (see Dyspepsia). Symptoms persist despite empirical therapy/H. pylori eradication. Suspected complications (bleeding). Suspicion of autoimmune gastritis or premalignant changes.

Red flags

  • Alarm features for dyspepsia (Weight loss, dysphagia, bleeding, anaemia, vomiting, mass)
  • Severe or persistent symptoms despite treatment
  • Signs of active bleeding (haematemesis, melaena, haemodynamic instability)

Signs and symptoms

  • Often asymptomatic, especially chronic forms.
  • Epigastric pain or discomfort (burning, gnawing, aching).
  • Nausea, vomiting.
  • Anorexia (loss of appetite).
  • Feeling of fullness or bloating after eating.
  • Heartburn (can overlap with GERD/dyspepsia).
  • Haematemesis ('coffee grounds' or fresh blood) or melaena if erosive/haemorrhagic.

Risk factors

  • Acute Gastritis:
  • - NSAID use (Aspirin, Ibuprofen, Diclofenac, etc.)
  • - Excessive alcohol consumption
  • - Severe stress (e.g., major surgery, trauma, burns, critical illness - 'stress ulcers')
  • - Bile reflux
  • - Infections (e.g., CMV, Herpes in immunosuppressed)
  • - Caustic ingestion
  • Chronic Gastritis:
  • - Helicobacter pylori infection (most common cause)
  • - Autoimmune gastritis (associated with pernicious anaemia)
  • - Chronic bile reflux
  • - Long-term NSAID use
  • - Radiation exposure

Diagnosis

Clinical assessment

Suspected based on dyspeptic symptoms (epigastric pain, nausea, anorexia). History important for identifying causes (NSAIDs, alcohol, H. pylori risk factors). Differentiate from PUD, GERD, dyspepsia, pancreatitis, cholecystitis, gastric cancer.

Investigations

  • Upper GI Endoscopy (OGD) with Biopsies: Gold standard for diagnosis. Allows visualization of inflamed/eroded mucosa and histological examination to confirm inflammation, identify cause (e.g., H. pylori), and rule out other pathology (ulcers, malignancy).
  • Helicobacter pylori testing (UBT, Stool Antigen, or biopsy-based tests - RUT, histology): Essential if chronic gastritis suspected.
  • Blood tests: CBC (check for anaemia from chronic blood loss), Vitamin B12 levels and autoantibodies (if autoimmune gastritis suspected).

Diagnostic criteria

Endoscopic and/or histological evidence of gastric mucosal inflammation.

Management

Non-pharmacological management

  • Identify and remove/avoid offending agents (NSAIDs, alcohol).
  • Dietary modification: Avoid irritant foods/drinks (spicy, acidic, caffeine - individual specific). Eat smaller, regular meals.
  • Smoking cessation.

Pharmacological treatment

  • Treat the Underlying Cause:
  • - H. pylori Eradication: If positive, use standard triple or quadruple therapy (see PUD section GI013).
  • - Stop NSAIDs/Alcohol.
  • Acid Suppression (Symptomatic relief and healing):
  • - Proton Pump Inhibitors (PPIs): Omeprazole 20-40mg OD (or equivalent) for 4-8 weeks.
  • - H2 Receptor Antagonists (H2RAs): Ranitidine/Cimetidine (less effective than PPIs).
  • Antacids: Temporary symptomatic relief (Magnesium Trisilicate).
  • Sucralfate: May provide mucosal protection (less commonly used).
  • Vitamin B12 injections: If pernicious anaemia secondary to autoimmune gastritis.
  • Management of Acute Haemorrhagic Gastritis:
  • - Resuscitation (fluids, blood transfusion if needed).
  • - High-dose IV PPI.
  • - Endoscopy for diagnosis and potential haemostasis.

Monitoring

  • Monitor symptom resolution.
  • Confirm H. pylori eradication if treated.
  • Endoscopic surveillance may be needed for certain chronic gastritis types (e.g., atrophic gastritis, intestinal metaplasia) due to increased cancer risk (specialist).

Complications

  • Peptic Ulcer Disease (PUD)
  • Upper GI Bleeding (erosive/haemorrhagic gastritis)
  • Gastric atrophy
  • Intestinal metaplasia
  • Increased risk of gastric adenocarcinoma and MALT lymphoma (esp. with chronic H. pylori or autoimmune gastritis)
  • Pernicious Anaemia (from autoimmune gastritis)

Prevention

  • Avoid excessive alcohol and NSAID use.
  • Treat H. pylori infection.
  • Smoking cessation.

Patient education

  • Explain gastritis and likely cause (H. pylori, NSAIDs, alcohol).
  • Importance of avoiding offending agents.
  • Dietary and lifestyle advice.
  • Medication use (PPIs, H. pylori eradication).
  • Need for follow-up and potential long-term risks (if chronic/atrophic).

Uganda-specific notes

H. pylori infection is highly prevalent. NSAID use is common. Consider empirical treatment or Test-and-Treat for H. pylori. Endoscopy access limited; rely on clinical assessment and response to treatment.

References

  • Uganda Clinical Guidelines (UCG) 2023

    Chapter 6, Section 6.3.4

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