Gastritis Types, Treatments, and Patient Education

• Gastritis is the inflammation of the mucosal membrane of the stomach.  It can occur in one region or it can consist of patches in many areas.  Typically, it is limited to the mucosa, but sometimes it involves deeper linings of the gastric wall.  
• Treatment can be both immediate and long-standing treatments by the use of pharmacology and the treatment also depends on whether the inflammation is acute or chronic. 
• Patient education is important in achieving optimal outcomes for patients experiencing acute and chronic cases.
  

Types of Gastritis

Gastritis is the inflammation of the mucosal membrane of the stomach.  It can occur in one region or it can consist of patches in many areas.  Typically, it is limited to the mucosa, but sometimes it involves deeper linings of the gastric wall. 

There are two classifications of gastritis: 

• Acute Gastritis – most common form is acute hemorrhagic gastritis, also known as acute erosive gastritis. That is usually caused by Helicobacter pylori, which can also lead to chronic gastritis. 
  

• Chronic Gastritis – involves superficial gastritis, atrophic gastritis, and gastric atrophy. Chronic gastritis can be further classified into type A and type B gastritis.  In Type A gastritis, the body of the stomach, the fundus is involved, rather than the antrum.  Type B gastritis is a more common non-autoimmune inflammation of the stomach lining and primarily involves the antrum but can affect the entire stomach as age increases. 
  

Patients with chronic gastritis have an  for gastric cancer or may develop chronic iron deficiency.  

If untreated this condition can also lead to hemorrhage, shock, gastric perforation, gastrointestinal (GI) obstruction, and peritonitis. 

Causes of Gastritis

The most common reasons for acute cases are alcohol consumption and NSAIDS  along with the ingestion of aspirin products.    

Other related factors can be as follows:  

• Steroid or digitalis medications 
• Ingestion of corrosive agents such as lye or drain cleaners 
• Ingestion of excessive amounts of tea, coffee, mustard, cloves, paprika, or pepper 
• Chemotherapy or radiation to the upper abdomen 
• Severe stress related to critical illness 
• Staphylococcus food poisoning 
• Infections such as candida, cytomegalovirus, and herpes virus in immunosuppressed patients
  

These conditions or substances can damage normal gastric mucosa and can increase the vulnerability of normal gastric secretions which can lead to complications.

Causes of Gastritis

The immediate treatment for acute gastritis is alleviating the causative agents and giving medications that can help relieve the symptoms.  Typically, the physician prescribes an H2 receptor antagonist such as cimetidine or famotidine. 

The medical goal is to maintain the gastric pH above 4, which means there is less acid than usual.  

For chronic gastritis, the necessary intervention is the eradication of Helicobacter Pylori and consists of a regimen consisting of a combination of bismuth salts and two antibiotics over 2 weeks. 

It is important to stress to the patient the importance of follow-up visits and screening for gastric cancer due to patients with chronic gastritis developing pernicious anemia due to the destruction of parietal cells in the fundus and body of the stomach leads to inadequate vitamin B12 absorption.  

Patient Education About Gastritis

Nurses have an important role in providing education to patients dealing with gastritis.  The following are important guidelines for nurses to encourage for these patients in order to achieve the most successful outcomes:

• Encourage the patient to avoid the intake of salicylates, such as aspirin, or other NSAIDs, such as ibuprofen or indomethacin unless prescribed by the physician.  Inform patients to take enteric-coated preparations if necessary and to take an NSAID with food to decrease stomach upset.  
• Inform the patient of other drugs that can irritate the gastric mucosa such as corticosteroids and various antibiotics including clarithromycin or erythromycin. These should be taken with food.   
• Explain the importance of reading the label of over-the-counter drugs to be aware if the preparation contains aspirin or any NSAID.   
• Instruct the patient about the dose and frequency of the prescribed drugs, such as a proton pump inhibitor or an antibiotic and the importance of taking these in a timely manner each day.   
• Discuss the complications of acute or chronic gastritis that include hemorrhage, pernicious anemia, iron deficiency anemia, or gastric cancer.  Also, it is essential to tell them about the pathophysiology and treatment of each condition.  
• Inform the patient that caffeine and spicy food intake can worsen the condition by causing irritation and inflammation of the gastric mucosa.  
• Ascertain that the patient understands how smoking and alcohol aggarvate gastritis and that abstaining from both will facilitate healing and reduce the recurrence of gastritis.  Guide the patient about smoking cessation and alcohol rehabilitation programs available in the community.  
• Assist the patient in identifying his or her personal physical and emotional stressors. Review coping skills that the patient has used previously to change behaviors.  It is important for the nurse to discuss the importance of creating an environment and lifestyle changes that encourage healing.  

The Bottom Line

Gastritis is a medical event that needs to be treated in order for more positive results and relief to be obtained.  If left untreated, it can lead to multiple and more serious complications. As a nurse, compelling the patient to adopt a healthy lifestyle that assists in the prevention of gastritis and its reoccurrence is of utmost importance.

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