1) Acute gastritis is caused by an imbalance between factors protecting and injuring the stomach lining, and has erosive and non-erosive forms. Common causes include NSAIDs, alcohol, H. pylori infections, and stress. 2) Symptoms include gnawing or burning epigastric pain and nausea/vomiting. Diagnosis is usually clinical but may include tests to check for dehydration or H. pylori. 3) Treatment depends on severity but typically involves IV fluids, analgesics, and PPIs. Uncomplicated cases may resolve with observation but H. pylori infections require antibiotic treatment. Complications include bleeding, obstruction, dehydration

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).