Gastritis

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This is an inflammatory mucosal response to injury from variety of agents and mechanisms including  infections, drugs, alcohol, acute stress, radiation, allergy, acid and bile, ischemia or direct trauma.  The inflammation may involve the entire stomach (pangastritis) or a region of the stomach (antral  gastritis) while the severity of inflammation may be erosive or non-erosive. 

Clinical presentation 

• Nausea, vomiting, loss of appetite, belching, and bloating
• Acute abdominal pain or abdominal discomfort
• Fever, chills, and hiccups also may be present

Investigations 

• Endoscopic evidence of gastric mucosal inflammation
• Histologic evidence of chronic active inflammation of biopsy specimen.

Non-pharmacological Treatment 

• Reduce the use of drugs known to cause gastritis (e.g., NSAIDs, alcohol)
• Stop smoking
• Reduce fatty, spicy and deep-fried foods

Pharmacological Treatment 

Triple therapy for H. pylori eradication if confirmed present.  

Administer fluids and electrolytes as required, particularly if the patient is vomiting. 

C: pantoprazole (IV) 40mg 6hourly 2-3days 

OR 

S: esomeprazole (IV) 40mg 12hourly 2-3days 

AND 

C: metoclopramide (IM) 10mg 12hourly when required (for cases presenting with intractable vomiting) in order to relieve symptoms.  

Switch to oral PPI once patient can tolerate oral intake.  

Referral 

Refer to next level service with adequate expertise and facilities for complicated case with alarm  features (anemia, vomiting blood and weight loss, see complete list under GERD above).