Module Id- F14TN11- Principles to conquer Gastritis- Types, Causes, symptoms, Diagnosis of gastritis-treatment-dietary Management

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1 Paper14-Therapeutic Nutrition Module Id- F14TN11- Principles to conquer Gastritis- Types, Causes, symptoms, Diagnosis of 1.Introduction Gastritis is nothing but an inflammation or injury of the gastric mucosa. When there is an injury in the mucous membrane lining of the stomach due to food or bacterial infection, allergy, and some drug ingestion there will be a white blood cell move to the wall of the stomach. 2.Objectives After going through this module, you will be able to Understand the various types of gastritis such as acute and chronic, nonerosive and erosive gastritis Learn the causes, symptoms and preventive measures to conquer gastritis Outline the principles in treatment and diet therapy in gastritis 3. Types of gastritis The common two types of gastritis are acute and chronic. 3.1.Acute gastritis may be severe erosive, and occur suddenly which lasts for a short time. In acute gastritis mucosal cells are damaged or cells may be missed. 3.2.Chronic gastritis may occur gradually, progress slowly but prolonged for a longer period. Gastritis may be a sign when the person is affected by pernicious anaemia or peptic ulcer or stomach cancer. Chronic gastritis may be primary or secondary Primary chronic gastritis When there is poor or irregular eating or fast eating or mental disturbance at mealtime primary chronic gastritis may be developed Secondary chronic gastritis If an individual is affected by ulcer, cancer, diabetes, gout, anaemia, nephritis, cirrhosis,problem in portal circulation, cardiac problem, swallowing infected sputum or pulmonary tuberculosis, inflammation is formed which is referred as secondary chronic gastritis.

2 . Chronic gastritis is often directly attributed to dietary indiscretion or indirectly to toxic substances; nevertheless, it may also occur in the absence of any known cause. 3.3.Other types of gastritis Acute stress gastritis occurs after surgery in critically ill patients. Severe trauma and stress to the lining of stomach develop stress erosion. Superficial gastritis or surface gastritis is the initial stage of chronic gastritis. Inflammation is mild only at the surface of the stomach lining without affecting deeper layer. Pan gastritis Inflammation is observed in entire part of the stomach lining which indicates that gastritis is everywhere. Bile gastritis (or bile reflux gastritis) this is a stomach inflammation resulting from bile produced by the liver leaking back into the stomach. ( It If not treated properly, the acidic fluids will keep eroding the stomach lining over time, and can even reach the esophagus and cause heartburn. Antral gastritis is the inflammation taking place in the antrum, which is the lower part of the stomach (that is the part that releases the contents of stomach into the intestines). Duodenal gastritis (or duodenitis) is inflammation of the duodenum, which is the first part of the small intestine located just below stomach. Atrophic gastritis occurs as a result of prolonged chronic gastritis. Hypochlorhydria or achlorhydria is common in atrophic gastritis. Hypochlorhydria is the diminished secretion of hydrochloric acid. Achlorhydria is a condition where there is absence of hydrochloric acid but there is still gastric juice and referred as gastric anacidity. Gastric atrophy is the end stage and may lead to gastric cancer What is gastric acid? Gastric acid is referred as hydrochloric acid (HCl). The parietal cells in the lining of the stomach secrete hydrochloric acid.the ph can be as low as 1.5.When food enters the mouth or start smelling food,body produces hydrochloric acid. Hydrochloric acid helps to break down the food chemically in the stomach and the process of digestion begins in the stomach. If too much of acid is produced in the stomach it causes pain and need medication to inactivate the production of hydrochloric acid.

3 3.3.2.Role of hydrochloric acid in stomach The gastric chief cells in the stomach secrete the inactive form of enzyme pepsinogen which is needed for the protein digestion.hydrochloric acid secreted in the stomach converts the inactive form of pepsinogen to active enzyme pepsin. The enzyme pepsin helps in the digestion of protein by breaking the bonds linking amino acids, a process known as proteolysis What is gastric juice? Gastric juice is a combination of mucus, hydrochloric acid and pepsin. Gastric juice mixes with food and produces chyme. This is released into the duodenum for further digestion How hydrochloric acid is produced in the stomach? Hydrochloric acid is produced in the parietal cells through series of complex reactions. Carbon dioxide diffuses into the parietal cells and the enzyme carbonic anhydrase catalyses the reaction between carbon dioxide and water to form carbonic acid. Carbonic acid dissociates into bicarbonate ion and hydrogen ion. The bicarbonate ion is transported back into the blood stream. An ion exchange molecule in the plasma membrane exchanges bicarbonate going out for chloride coming in. The hydrogen ions actively transported into the duct of the gastric acid and the negatively charged chloride ions diffuse with the positively charged hydrogen ions. Potassium ions are counter transported into the parietal cell in exchange for hydrogen ions. Outcome of this process is the production of hydrochloric acid in the parietal cells and its secretion into the duct of the gastric gland. Toxic gastritis occurs due to ingestion of a corrosive substance like acid or poison. Other than these less common gastritis are granulomatous, eosiniphilic and lymphocytic gastritis 4.Causes of gastritis The foremost contributory factor of gastritis is infection. The infections may be due to bacteria, virus and parasite; fungal infections; use of certain medications; stress reaction; bile reflex; radiation; trauma; eating too fast; eating when too much tired; eating when psychologically affected; if the food is allergic or sensitive; food poisoning due to toxins of bacterial origin- salmonella and staphylococcus, uremia; syphilis; toxins due to metabolic origin; intake of corrosive substances; excessive consumption of alcoholor tobacco; drugs such as salicylate, phenyl butazone; and gastric irradiation. Male population are more affected than female population.

4 Helicobacter pylori (H. pylori) bacteria is responsible for both acute and chronic gastritis in the stomach mucosa. Initially the infection of H. pylori affects the stomach mucosa at antrum.this results in the prevention of secretion of acid producing cells and become acute. If it prolongs and progresses, infection may continue and end up with chronic gastritis which lasts for long years. The second factor for acute and chronic gastritis is non steroidal anti inflammatory drugs NSAIDs. Besides this gastritis is also developed when there is a back flow of bile from the bile tract that connects to the liver and gallbladder to the stomach. 4.1.Non erosive H. pylori gastritis Studies state that the infection starts mainly from childhood. There is no clear evidence for the origin of the way it spreads but it is true that the transmission of infection is possible by many ways. The prevalence of infection and distribution varies nationally and globally. The presence of H. pylori has been detected in 86-99per cent of patients with chronic superficial gastritis. However, physicians are still learning about the link of H. pylori to chronic gastritis and peptic ulcers, since many patients with H. pylori infection do not develop symptoms or peptic ulcers. H. pylori is also seen in per cent of patients with duodenal ulcers. The major symptoms of gnawing pain in the stomach and lowering of gastric acid secretion are observed in H. pylori gastritis. Sometimes the patients with H. pylori gastritis may be asymptomatic. However if the H. pylori infection is one of the causes for ulcer development. They may may have the symptoms like weariness, intermittent abdominal pain after two or three hours of eating food, and pain in the middle of the night when the stomach is empty. 4.2.Erosive gastritis Use of pain killers specially nonsteroidal anti inflammatory drugs is \the next common factor for chronic gastritis. The drugs such as aspirin, fenoprofen, ibuprofen and naproxen used as pain killers are responsible for gastritis and peptic ulcer. Besides the causes of infection and medication, consumption of alcohol, use of corrosive agents and foreign bodies are the other factors for the occurrence of erosive gastritis. 4.1.Type A chronic gastritis It is asymptomatic and otherwise known as autoimmune gastritis. Fundus of stomach is mainly affected in chronic gastritis. In this condition, there may be inadequate secretion of intrinsic factor from the stomach cells. The absorption of vitamin B12 is disturbed in the absence of intrinsic factor which results in pernicious anaemia.

5 4.2.Type B chronic gastritis The main part affected is antrum and the lower end of the duodenum that is pylorus.it is symptomatic. The common symptoms are poor or lack of appetite, heart burn after the ingestion of food, nausea, vomiting, and a sour taste in the mouth Pathology: Three states of chronic gastritis are usually considered in dealing with its pathology are Simple catarrhal: In this type an increased amount of mucin is secreted. This is mixed with the food which is taken and may be vomited or may be passing on into the intestine and be digested. The mucous membrane may be greyish in colour and usually shows small hemorrhagic area, especially near the pylorus Hypertrophic gastritis: It is characterized by changes in the mucous membrane with overgrowth of the muscular and connective tissue walls of the stomach. The walls may become thick and the contraction of the newly formed connective tissue so profound, that the lumen of the stomach is greatly diminished. The intense multiplications of muscular and connective tissues lessen the elasticity of the mucous layer of the stomach, interferes with the circulation of blood and probably exerts more or less of a pressure effect upon the nerve plexus and nerve endings Atrophic gastritis: This represents the terminal stage of chronic gastritis. The surface of the stomach is smooth, glistering grayish like a thin sheet of connective tissue. But generally, the stomach is let in the form of a thin, smooth, dry, inelastic bag which forms no secretion, originates no sensory impulse nor is capable of reacting to any nervous stimulation.

6 5.Symptoms There are no symptoms in gastritis for many people. Gastritis is diagnosed only when examined the samples of stomach mucosa for other suspected diseases. However heart burns after meals or diner at night, intermittent or constant gastric or abdominal pain, epigastric discomfort, intermittent gnawing pain accompanied by nausea and vomiting and sometime diarrhoea are the common symptoms noticed. Loss of appetite, dyspepsia(indigestion),hiccups, belching and abdominal bloating are other symptoms that may occur in gastritis. The symptoms commonly experienced by patients with chronic stage of gastritis are dull pain, anorexia or loss of appetite, andabdomen distension after the intake of foods. In severe cases hemorrhage may be seen. But there may be individual differences in the symptoms. 5.1.The problems of gastritis When the gastritis is prolonged over a period of time it may lead to chronic stage and if the causes are unnoticed without treatment several problems may arise. This may result in

7 complications like anaemia, peptic ulcer, bleeding ulcers, gastric cancers, scar in the gastric mucosa, and obstruction, dehydration, difficulty in urination and end of life. 6.Diagnosis Presumptive diagnosis can be done based on the symptoms of the patients, history of previous diagnosis,and treatment of gastritis, alcohol consumption, and use of NSAIDs. In order to identify the causes of chronic gastritis and to visualize the mucosal erosion changes in mucosa.definitive diagnosis can be made by identifying the cause of gastric mucosal inflammation and gastric (tissue) biopsy during biopsy test. Presence of Helicobacter pylori(h. pylori) can be detected by breath, blood, stool,immunological and biopsy tests. Abdominal X-rays or barium studies may demonstrate the presence of thickened mucosa and folds that are signs of inflammation in the stomach Red blood cell count is done to detect the presence of anaemia. Screening for H. pylori infection and pernicious anaemia can be done. Fecal occult blood test is done to check the presence of blood in the stool, a possible sign of gastritis. Chronic gastritis type A is diagnosed by endoscopy, upper GI x-ray examination and gastric aspirate analysis. 7.What is the treatment for gastritis? It is a need for an individual with gastritis to reduce gastric acidity by including antacids. Hot foods and spicy foods can be avoided to prevent the stimulation of excess acid secretion and irritation to the stomach lining. If H. pylori is the cause for gastritis physician may prescribe antibiotics and acid blocking drug to control heart burn 7.1.Vitamin B12 or an iron deficiency and gastritis Deficiencies of vitamin B-12 and iron will not cause gastritis or gastro esophageal reflux disease(gerd). Hydrochloric acid plays a key role in the absorption of iron as well as water soluble cobalamin(vitamin B12 ). Therefore, an acid deficiency can easily result in a nutrient deficiency. Iron and vitamin B12 supplements may be desirable.moreover vitamin B12 is helpful if the patients with atrophic gastritis are affected by pernicious anaemia

8 The anti oxidants both vitamin C and beta-carotene promote the healing of inflammation in chronic atrophic gastritis patients The enzyme bromelain present in pineapple has anti-inflammatory properties,which helps to reduce the irritation in the stomach. But pineapple juice rich in acidic is not preferable for gastritis patients. Avoid self medication and consult the doctor for stopping or changing of medication for the effective recovery and treatment. 7.2.What is the prognosis of gastritis? It is possible to recover from gastritis if the patients are affected by short term symptoms. I t is imperative that by knowing the causes if appropriate treatment is given successfully gastritis patients can recover. With careful effort the development of bleeding ulcer, obstruction and cancer the prognosis of individuals with chronic gastritis can be protected 7.3.How is gastritis prevented? By following suitable measures the causes for the occurrence of gastritis can be controlled by which the occurrence of gastritis can be prevented. If the gastritis is by infection it is essential to follow hygienic practices such as preparing food hygienically, washing hands thoroughly using soap before eating, consuming healthy foods and drinking adequately boiled cooled water or fluids stored in clean vessel so as to reduce the risk of being affected by gastritis. When the gastritis is by the ingestion of NSAIDs or alcohol avoid consuming these items to prevent the health problems. 8.Dietary management Correct faulty dietary habits Should have a relaxed atmosphere at meal time Include adequate caloric intake of soft or bland foods. Four or six small feeding of meal is preferred. Once symptoms have abated, progression to a normal diet may be made. 8.1.Foods to be restricted or avoided Hot beverages with cocoa Chocolate containing items like cake and chocolate milk shake Spices, high fat food that cause irritation to stomach. Whole milk Decaffeinated or caffeine containing coffee or tea Green and black tea, with or without caffeine Alcoholic beverage 8.2.Spices and seasonings-

9 Seasonings, such as pepper increase stomach acid and may irritate the stomach. Avoid black and red pepper, garlic powder and chilli powder 8.3.Other foods- Milk products using whole milk or cream Meat rich in fats like sausage, bacon, ham, and cold cuts Processed products of tomato sauce, paste,juice Refined cereal foods like maida Avoid refined sugars. Use unrefined sweeteners including honey and maple syrup. Reduce the intake of red meats. Repeated use of fats and oils in deep fat fried items which may release trans-fatty acids. In order to prevent the intake of trans fatty acid avoid fried items like chips, French fry, onion ring and commercially prepared baked items like cakes and cookies. Avoid pickles, peppers, spicy and very salty food products. Avoid vinegar, and foods prepared made using vinegar 8.4.Soda- Soda damages the stomach lining since it is carbonated, caffeinated and found to be acidic. University of Maryland Medical Center recommends that all carbonated drinks can be avoided to get relief from the symptoms of gastritis. But very small amount of bubbly beverages occasionally without filling the stomach can be included 8.5.Include the following Flavonoids inhibit the inflammatory activity. So the growth of H.pylori can be prevented by flavonoids. Flavonoids containing foods like apple, blue berries, celery, onion and tea can be consumed. Peanuts, broad beans, spinach, straw berry, guava and the anti oxidant foods can be included. Protein rich foods like legumes, fish, nuts and seeds Fruits and vegetables rich in anti oxidant sources are preferable Foods like almonds, broccoli, dark green leafy vegetables and raisins are rich in calcium and vitamin B can be eaten liberally. Include fresh tender coconut water Consume whole grain once you become normal. Practice exercise in your routine. Since exercise is good for healthy living everyday walk for half an hour.

10 Conclusion If one can adopt healthy life style pattern with regular exercise and good eating pattern by including adequate antioxidant foods, avoiding carbonated and caffeine containing beverages, alcohol, acid foods, spicy foods and deep fat fried foods or trans fat and follow relax atmosphere and adhere hygienic practices in preparation of foods it is possible to protect the oneself from the sufferings of gastritis problem which in turn prevent the incidence of peptic ulcer also