From the Guidelines
Gastritis typically presents with epigastric pain, nausea, vomiting, and occasionally hematemesis or melena, with the clinical presentation varying based on the underlying cause, such as H. pylori infection, NSAID use, alcohol consumption, and autoimmune processes 1. The symptoms of gastritis can range from mild to severe and may include:
- Epigastric pain that is burning or gnawing in nature and may worsen after meals
- Nausea and vomiting
- Early satiety
- Bloating and belching
- Indigestion
- In severe cases, hematemesis or melena may occur Physical examination may reveal epigastric tenderness on palpation, though findings can be normal. Systemic symptoms like fever are uncommon unless there's a severe infection. In elderly patients, symptoms may be less pronounced or atypical. The diagnosis of gastritis typically requires endoscopy with biopsy to confirm inflammation of the gastric mucosa and identify the underlying cause 1. Alarm symptoms warranting immediate attention include:
- Weight loss
- Persistent vomiting
- Dysphagia
- Anemia
- Gastrointestinal bleeding as these may indicate complications or more serious conditions like gastric cancer 1. It is essential to note that atrophic gastritis, a common preneoplastic condition of the stomach, should be confirmed by histopathology, regardless of the etiology 1. The clinical presentation of gastritis can vary based on the underlying cause, and it is crucial to identify the cause to provide appropriate treatment and prevent complications. In the context of real-life clinical medicine, it is essential to prioritize the diagnosis and treatment of gastritis to prevent morbidity, mortality, and improve quality of life. The most recent and highest quality study recommends that the diagnosis of atrophic gastritis should be confirmed by histopathology, and treatment should be guided by the underlying cause 1.
From the Research
Gastritis Clinical Presentation
The clinical presentation of gastritis can vary, but it is often associated with Helicobacter pylori (H. pylori) infection.
- H. pylori infection is a significant risk factor for gastric-related diseases, and antibiotic therapy has become an effective treatment 2.
- The combination of omeprazole, amoxicillin, and clarithromycin is a common regimen against H. pylori, with an overall eradication rate of 72% 3.
- Factors such as smoking, high intragastric acidity, and the degree of histological gastritis can affect H. pylori eradication failure 3.
Treatment Options
Several treatment options are available for H. pylori eradication, including:
- Proton-pump inhibitor and amoxicillin-based triple therapy containing clarithromycin (PAC) or metronidazole (PAM) 2, 4.
- Omeprazole, clarithromycin, and amoxicillin therapy for one or two weeks 5.
- The importance of clarithromycin dose in the management of H. pylori infection, with 500 mg b.d. being more effective than 250 mg b.d. 6.
Eradication Rates
The eradication rates of H. pylori infection vary depending on the treatment regimen, with:
- PAC regimen achieving an eradication rate of 71.0% 2.
- PAM regimen achieving an eradication rate of 75.2% 2.
- Omeprazole, metronidazole, and amoxicillin regimen achieving an eradication rate of 96.4% 4.
- Omeprazole, clarithromycin, and amoxicillin therapy for one week achieving an eradication rate of 89.6% 5.