Erosive gastritis

Erosive gastritis is an erosion of the gastric mucosa caused by damage to the protective factor of the mucosa. This disease of the gastrointestinal tract usually occurs acutely, complicated by bleeding, but can be subacute or chronic with mild symptoms or no signs at all. The diagnosis is established by endoscopy. Treatment of erosive gastritis is aimed at eliminating the cause of inflammation.

Read also:

• Gastritis
• Nonerosive gastritis
• Chronic gastritis caused by Helicobacter pylori

For some patients in the intensive care unit (e.g., mechanical ventilation, head injury, burn injury, combined injury), it is advisable to prescribe drugs that suppress acidity to prevent erosions.

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What causes erosive gastritis?

Causes of erosive gastritis include nonsteroidal anti-inflammatory drugs, alcohol, stress and, less commonly, radiation, viral infection (eg, cytomegalovirus), vascular disorders, and direct trauma to the mucosa (eg, nasogastric intubation).

Erosive gastritis is characterized by superficial erosions and point lesions of the mucous membrane. They can develop 12 hours after the initial injury. Deep erosions, ulcers and sometimes perforation can be observed in severe cases of the disease or in the absence of treatment. Lesions are usually localized in the body of the stomach, but the antrapic section can also be involved in the process.

Acute stress gastritis as a form of erosive gastritis develops in approximately 5% of critically ill patients. The likelihood of developing this form of gastritis increases with the length of the patient's stay in the intensive care unit and depends on the time the patient is without enteral nutrition. The pathogenesis probably includes hypoperfusion of the gastrointestinal mucosa, leading to the destruction of the protective factor of the mucosa. Increased acid production is also possible in patients with craniocerebral trauma or burns.

Symptoms of erosive gastritis

Moderate erosive gastritis is often asymptomatic, although some patients complain of dyspepsia, nausea, or vomiting. Often the first manifestation may be hematemesis, melena, or blood on nasogastric intubation, usually within 2 to 5 days of exposure to the etiologic factor. Bleeding is usually moderate, although it may be massive if deep ulceration occurs, especially in acute stress gastritis.

Diagnosis of erosive gastritis

Acute and chronic erosive gastritis are diagnosed by endoscopy.

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Treatment of erosive gastritis

In severe gastritis, treatment of bleeding requires intravenous fluids and, if indicated, blood. Endoscopic hemostasis should be performed; surgical treatment (total gastrectomy) is indicated only as a last resort. Angiography is unlikely to be effective in stopping severe gastric bleeding due to numerous collaterals in the stomach. Acid suppression should be started immediately if the patient has not received it.

In case of moderate gastritis, eliminating the etiological factor and using medications that reduce stomach acidity may be sufficient.

How to prevent erosive gastritis?

Prevention of erosive gastritis may mitigate the impact of stress on the development of acute gastritis. However, this mainly concerns high-risk patients requiring intensive care, including those with severe burns, CNS injuries, coagulopathy, sepsis, shock, multiple trauma, mechanical ventilation for more than 48 hours, liver or kidney failure, multiple organ dysfunction, and a history of peptic ulcer or gastrointestinal bleeding.

Erosive gastritis can be prevented by following preventive measures aimed at increasing the gastric pH above 4.0 and consisting of intravenous H2 _blockers, proton pump inhibitors, and oral antacids. Repeated pH measurement and changes in prescribed therapy are not required. Timely enteral nutrition can also reduce the likelihood of bleeding.

Acid suppression is not recommended in patients on single use of nonsteroidal anti-inflammatory drugs or without a history of ulceration.