Can acute gastroenteritis cause gastritis?

Can Acute Gastroenteritis Cause Gastritis?

Yes, acute gastroenteritis can cause gastritis as part of the inflammatory response to infectious agents that affect the gastrointestinal tract, particularly during severe infections that damage the gastric mucosa. 1, 2

Pathophysiological Relationship Between Gastroenteritis and Gastritis

Inflammatory Process

• Acute gastroenteritis involves inflammation that can extend throughout the gastrointestinal tract, including the stomach lining (gastric mucosa), resulting in gastritis 1
• The inflammatory response to infectious agents can cause significant alterations in the gastric mucosa, particularly during severe infections 2
• Infectious gastroenteritis produces a profound depletion of the commensal microbiota, which can disrupt the protective mechanisms of the gastric mucosa 1

Common Infectious Agents

• Viral agents (Norovirus/Rotavirus) account for approximately one-third of gastroenteritis episodes and can affect the gastric mucosa 1
• Bacterial pathogens like Campylobacter, Salmonella, and Shigella (accounting for 10%, 3%, and other percentages of cases respectively) can cause more severe mucosal inflammation extending to the stomach 1
• More invasive bacterial pathogens are associated with higher degrees of inflammation throughout the gastrointestinal tract, including the stomach 3

Clinical Manifestations

Symptoms Overlap

• Symptoms of gastritis and gastroenteritis often overlap, including nausea, vomiting, and abdominal pain 4, 2
• Acute onset of fever and vomiting followed by diarrhea within 24-48 hours is typical of infectious gastroenteritis that may involve gastritis 1
• The severity of gastritis symptoms correlates with the virulence of the pathogen and the extent of mucosal damage 1, 3

Distinguishing Features

• Gastritis specifically refers to inflammation of the gastric mucosa, while gastroenteritis indicates inflammation of both the stomach and intestines 5, 2
• Gastritis may present with more prominent upper abdominal pain and less diarrhea compared to classic gastroenteritis 2
• Severe cases of infectious gastroenteritis with significant vomiting are more likely to cause concurrent gastritis 6

Diagnostic Considerations

Clinical Assessment

• Clinical assessment should focus on identifying signs of dehydration, which is common in both conditions 1, 7
• Visual examination of stool can help determine the presence of blood or mucus, which may indicate more severe inflammation extending throughout the GI tract 1
• Laboratory tests including leukocyte count may help distinguish bacterial from viral etiologies, with bacterial causes more likely to cause gastritis 3

Endoscopic Findings

• Endoscopy is not routinely recommended for acute gastroenteritis but may be considered when symptoms persist or are severe 1
• When performed, endoscopy may reveal inflammatory changes in the gastric mucosa consistent with gastritis in patients with acute gastroenteritis 1

Management Implications

Treatment Approach

• Oral rehydration therapy remains the cornerstone of treatment for both conditions 1, 6
• Management should focus on preventing dehydration and providing appropriate rehydration rather than targeting the gastritis specifically 4, 7
• Antiemetics may be considered to control vomiting, which can improve tolerance of oral rehydration and indirectly help manage gastritis symptoms 6

Cautions

• Non-specific antidiarrheal agents are not recommended as they may prolong exposure of the gastric mucosa to pathogens 1
• Antibiotics should be used selectively based on the identified pathogen and severity of illness, not routinely 5

Long-term Consequences

Post-Infectious Complications

• Approximately 9% of patients with acute gastroenteritis develop post-infectious irritable bowel syndrome (PI-IBS) 5, 1
• Gastritis resulting from acute gastroenteritis typically resolves with the resolution of the infection, but may contribute to persistent symptoms in some cases 1
• The risk of developing chronic gastritis after acute infectious gastroenteritis is lower than the risk of developing PI-IBS 1

Special Considerations

High-Risk Populations

• Children, elderly persons, and immunocompromised patients may experience more prolonged and severe courses of illness, increasing the risk of gastritis 1, 3
• Patients with pre-existing gastric conditions may be more susceptible to developing gastritis during episodes of acute gastroenteritis 2

In conclusion, while gastroenteritis and gastritis are distinct clinical entities, acute infectious gastroenteritis can indeed cause gastritis as part of the inflammatory process affecting the gastrointestinal tract, particularly with more virulent pathogens and severe infections.