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Acute gastritis

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Acute gasritis is an acute mucosal inflammatory process, usually of a transient nature. The inflammation may be accompanied by hemorrhage into the mucosa and in more severe circumstances by sloughing of the superficial mucosa. This severe erosive form of the disease is an important cause of acute gastrointestinal bleeding.

The pathogenesis of poorly understood in part because normal mechanisms for gastric mucosal protection are not clear. Acute gastritis is frequently associated with the following:

Heavy use of nonsteroidal anti-inflammatory drugs (NSAIDs) PARTICULARLY ASPIRIN
Excessive alcohol consumption
Heavy smoking
Treatment with cancer chemotherapeutic drugs
Uremia
Systemic infections (e.g., salmonellosis)
Severe stress (e.g.,trauma, burns, surgery)
Ischemia and shock
Sucidal attempts, as with acids and alkali
Gastric irradiation or freezing
Mechanical trauma (e.g., nasogastric intubation)
After distal gastrectomy

One or more of the following influences are thought to be operative in these varied settings: increased acid secretion with back-diffusion decreased production of bicarbonate buffer, reduced blood flow, disruption of the adherent mucus layer, and direct damage to the epithelium. Not surprisingly, mucosal insults can act synergistically. Thus , ischemic injury would worsen the effects of back diffusion of hydrogen ions. Other mucosal insults have been identified, such as regurgitation of detergent bile acids and lysolecithins from the proximal duodenum and inadquate mucosal synthesis of prostaglandins. A substantial portion of patients have idiopathic gastritis, with no associated disorders.

In its mildest form, the lamina propria exhibits only moderate edema and slight vascular congestion. The surface epithelium is intact and scattered neutrophils are present among the surface epithelia cells or within the epithelial layer and lumen of mucosal glands. The presence of neutophils above the basement membrane (within the epithelial space) is abnormal and signifies active inflammation (activity). With more severe mucosal damage, erosion and hemorrhage develop. Erosion denotes loss of the superficial epithelium, generating a defect in the mucosa that does not cross the muscularis mucosa. It is accompanied by a rubust acute inflammatory infiltrate and extrusion of a fibrin-containing purulent exudate into the lumen. Hemorrhage may occur independently, generating pupctate dark spots in an otherwise hyperemic mucosa or in association with erosion. Concurrent erosion and hemorrhage is termed acute erosive gastritis. Large areas of the gastric mucosa may be denuded, but the involvement is superficial and rarely affects the entire depth of the mucosa. These lesions are but one step moved from stress ulcers.

Clinical features

Depending on the severity of the anatomic changes acute gastritis may be entirely asymptomatic may cause variable epigastric pain, nausea and vomiting or may present with overt hemorrhage, massive hematemesis, meleno, and potentially fatal blood loss. Overall, it is one of the major causes of massive hematmesis as in alcholics. Ion particular settings, the condition is quite common. As many as 25% of persons who take daily aspirin for rhematoid arthritis develop acute gastritis at some time many with bleeding.

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