a concise approach to the emergency treatment of acute gastritis

1. EMERGENCY MANAGEMENT
OF ACUTE GASTRITIS
DR. AWALA DE

2. INTRODUCTION
• Acute gastritis is a term that encompasses a broad spectrum of entities that
induce inflammatory changes in the gastric mucosa.
• It consist of two broad categories: erosive and non-erosive gastritis.
• Etiology:
• - drugs e.g NSAIDs, corticosteroids, anticancer drugs.
• - alcoholic drinks; whisky, vodka, gin etc
• - bile reflux
• - infections; bacterial (H. pylori), viral (CMV), fungal
• - Acute stress (shock)

3. • Pathophysiology:
• The common mechanism of injury is an imbalance between the aggressive
and the defensive factors that maintain the integrity of the gastric lining
(mucosa).
• Clinical features:
• Gnawing or burning epigastric pain,
• Nausea and/or vomiting.
• The pain may improve or worsen with eating.

4. MANAGEMENT
• History:
• History of burning or gnawing epigastric distress, associated nausea or
vomiting, variation of pain with meals
• History of exposure to potentially noxious drugs or chemicals that can
cause gastritis.
• Prior history of mucosal injury (peptic ulcer disease, previous history of
gastritis)
• Ask about red flags; anaemia, weight loss, anorexia, dysphagia, melena
stools.
• Examination:

5. • DIAGNOSIS: Usually clinical,
• INVX: FBC & Differentials, Serum E/U/Cr (for those vomitting and
dehydrated), H. pylori antigen/antibody test, fecal occult blood
test, endoscopy (usually reserved for patients older than 45 years
with alarm symptoms)
• TREATMENT: DEPENDS ON THE PRESENTATION;
• IN UNCOMPLICATED CASES: admit patient for observation,
• set up an iv access and collect samples for investigation,
• Administer iv fluid (normal saline) if patient is dehydrated,
analgesia IM PCM 600mg stat, iv pentazocine 30mg stat, and a
proton pump inhibitor iv omeprazole 40mg stat
• Review after 4-6hours, most times symptoms would have abated.

6. MANAGEMENT
• if patient is tolerating orally, placed on triple or
quadruple H. pylori eradication therapy, if found to have
H. pylori colonization.
• Omeprazole 20MG BD, Clarithromycin 500MG BD, Amoxicillin
1G BD OR Metronidazole 400MG tds all for 2 weeks.
• OR
• bismuth subsalicylate 525 MG QDS, Tetracycline 500MG QDS,
Lansoprazole 30 MG BID AND Metronidazole 500MG TDS all
for two weeks.

7. COMPLICATIONS
COMPLICATIONS OF ACUTE GASTRITIS INCLUDE THE FOLLOWING:
• Bleeding from an erosion or ulcer
• Gastric outlet obstruction due to edema limiting an adequate transfer of
food from the stomach to the small intestine
• Dehydration from vomiting
• Renal insufficiency as a result of dehydration

8. PREVENTION
• ALSO CONSIDER:
• Eating smaller, more frequent meals
• Avoiding foods that can irritate the stomach, such as spicy, acidic or fried
foods
• Avoiding or cut down on alcohol intake.
• Counsel to Quitting smoking (for persons smoking).