| disease | Acute Gastritis |
| alias | Acute Simple Gastritis, Acute Gestritis |
Acute gastritis is an acute inflammation of the gastric mucosa caused by various disease factors. Clinically, it can be classified into simple, erosive, corrosive, and suppurative types, with the simple type being the most common. Some categorize it into acute exogenous and acute endogenous types. Gastritis caused by pathogenic factors entering the stomach orally is termed exogenous gastritis, including bacterial gastritis, toxic gastritis, corrosive gastritis, and drug-induced gastritis. Gastritis caused by harmful factors reaching the gastric mucosa through the bloodstream is called endogenous gastritis, including gastritis associated with acute infectious diseases, systemic diseases (such as uremia, cirrhosis, pulmonary heart disease, respiratory failure, etc.), suppurative gastritis, allergic gastritis, and stress-related lesions. In recent years, with the widespread use of endoscopy, stress-related lesions have been found to be very common and are one of the leading causes of acute upper gastrointestinal bleeding.
bubble_chart Etiology
(1) Physicochemical Factors Overly cold or hot food and drinks, strong tea, coffee beans, hard liquor, spicy condiments, excessively coarse food, and medications (especially nonsteroidal anti-inflammatory drugs such as aspirin, indomethacin, etc.) can irritate the gastric mucosa and damage the mucosal barrier. Drugs like aspirin can also interfere with the synthesis of sulfated glycoproteins by gastric mucosal epithelial cells, reducing gastric mucus and weakening the protective effect of the lipoprotein membrane. This leads to the back-diffusion of hydrogen ions in the gastric cavity, causing mast cells in the mucosal lamina propria to release histamine and increasing vascular permeability. As a result, pathological processes such as gastric mucosal congestion, edema, erosion, and bleeding occur. The synthesis of prostaglandins is also inhibited, affecting the repair of the gastric mucosa.
(2) Biological Factors Bacteria and their toxins. Common pathogenic bacteria include Salmonella, halophilic bacteria, and pathogenic Escherichia coli, while common toxins are those produced by Staphylococcus aureus or Clostridium botulinum, with the former being more prevalent. Consuming food contaminated with bacteria or toxins can lead to gastritis or concurrent enteritis within hours, known as acute gastroenteritis. Ingestion of Staphylococcus aureus and its toxins can cause symptoms even faster. In recent years, viral infections have also been identified as a rare cause of this condition.(3) Other Factors Foreign bodies or bezoars in the stomach, as well as radiation therapy to the gastric region, can act as exogenous irritants, leading to this disease. Emotional fluctuations, stress, and allergic reactions triggered by various internal factors can serve as endogenous stimuli and contribute to the condition.
bubble_chart Pathological Changes
The lesion can be diffuse or limited to catarrhal inflammation of the antral mucosa. The mucosa is congested and edematous, covered with exudate and mucus, and may exhibit punctate hemorrhage and varying degrees of erosion. The mucosa is infiltrated with lymphocytes, neutrophils, plasma cells, and a few eosinophils, along with edema and vascular congestion. Occasionally, there may be small interstitial hemorrhages. In severe cases, the submucosa shows edema and congestion.
bubble_chart Clinical Manifestations
Most cases have an acute onset with varying severity of symptoms. The main manifestations include upper abdominal fullness, dull pain, decreased appetite, belching, nausea, and vomiting. In severe cases, vomitus may contain traces of blood. When caused by Salmonella or Staphylococcus aureus and their toxins, symptoms typically appear within hours or up to 24 hours after ingestion of contaminated food, often accompanied by diarrhea and fever. Severe cases may present with dehydration, acidosis, or shock. Laboratory tests reveal an increase in peripheral white blood cell count with neutrophilia. X-ray examinations show rough mucosal lesions, localized tenderness, and irritability. Endoscopic findings include gastric mucosal congestion, edema, exudation, spotty hemorrhage, or erosions.
There are often predisposing factors such as improper diet, excessive alcohol consumption, or taking irritating medications. Subsequently, symptoms such as upper abdominal pain, loss of appetite, belching, nausea, and vomiting may appear. Cases caused by food poisoning are often accompanied by acute enteritis, manifesting as periumbilical pain, diarrhea, fever, dehydration, or even shock. Upper gastrointestinal bleeding may also occur. Therefore, patients should be asked about the location, nature, and characteristics of the pain, accompanying symptoms, and possible triggers. Physical examination may reveal tenderness in the upper abdomen and around the navel, hyperactive bowel sounds, and occasionally fever. Attention should be paid to signs of dehydration or even shock. Blood tests and emergency gastroscopy should be performed as appropriate.
bubble_chart Treatment Measures
Antispasmodic and analgesic: 654-2 10mg, intramuscular injection, as needed, or orally, 3 times daily.
Antiemetic: Metoclopramide 10mg, orally, 3 times daily. Acupuncture at Zusanli (ST36) and Neiguan (PC6).
Anti-infection: Ciprofloxacin 0.2～0.4, orally, 3 times daily, or Norfloxacin 0.2, orally, 3 times daily, or Amoxicillin 0.25～0.5, orally, 3 times daily.
Gastric mucosa protection: Tagamet 0.4, orally, 2 times daily, Sucralfate 1.0, orally, 3 times daily, Marzulene-S granules 1 packet, orally, 3 times daily.
Correct typical edema, electrolyte, and acid-base balance disorders.
This disease is a self-limiting pathological process with a short course. It can heal on its own after removing the causative factors. Except for rare cases where severe consequences may occur due to massive hemorrhage, the prognosis is generally good even without treatment.
It should be differentiated from early acute appendicitis, acute cholecystitis, acute pancreatitis, etc. Endoscopy is helpful for diagnosis and differential diagnosis.
