Gastritis (source from Dambro)
•Patchy erythema of gastric mucosa: a common endoscopic finding; usually insignificant
•Erosive gastritis: a reaction to mucosal injury by a noxious chemical agent, e.g., drugs (especially NSAID's) or alcohol
•Reflux gastritis: a reaction to protracted reflux exposure to bile and pancreatic juice, usually associated with a defective pylorus; typically limited to the prepyloric antrum
•Hemorrhagic gastritis (stress ulceration): a reaction to hemodynamic disorder, eg, hypovolemia or hypoxia (as in shock). Also, very common in intensive care units (ICU).
•Infectious gastritis: commonly associated with Helicobacter pylori (possibly causative, maybe opportunistic); viral infection, usually as a component of systemic infection, is common; significant infection by other specific microbes is rare
•Gastric mucosal atrophy, sometimes called atrophic gastritis: frequent, in varying degrees, in the elderly; invariable in primary (pernicious) anemia
SIGNS AND SYMPTOMS:
•Nondescript epigastric distress, often aggravated by eating•Anorexia
•Nausea, with or without vomiting
•Significant bleeding is unusual except in hemorrhagic gastritis
•Hiccups
CAUSES:
•Alcohol•Aspirin and other nonsteroidal anti-inflammatory drugs
•Bile reflux
•Pancreatic enzyme reflux
•Stress (hypovolemia or hypoxia)
•Radiation
•Staphylococcus aureus exotoxins
•Bacterial infection (eg: Helicobacter pylori)
•Viral infection
•Pernicious anemia
•Gastric mucosal atrophy
•Portal hypertension gastropathy
RISK FACTORS:
•Age over 60•Exposure to potentially noxious drugs or chemical agents
•Hypovolemia, hypoxia (shock)
•Candidal autoimmune
MEDICATIONS
DRUG(S) OF CHOICE:
•Antacids - best given in liquid form, 30 mL 1 hour after meals and at bedtime; useful mainly as an emollient•H2 receptor antagonists e.g., cimetidine (Tagamet) - "priming" dose of 300 mg IV, then a steady infusion of 37.5-75 mg per hour, dissolved in the running fluid. Patients less severely ill - oral cimetidine 300 mg q6h (or ranitidine [Zantac] or famotidine [Pepcid] or nizatidine [Axid]). Not shown to be clearly superior to antacids.
•Sucralfate (Carafate) 1 g q4-6h on an empty stomach. Rationale uncertain, but empirically helpful.
•Prostaglandins, e.g., misoprostol (Cytotec), can help allay gastric mucosal injury, suggested dosage of 100-200 µg qid
•To eradicate H. pylori:
•"Triple therapy" is advised - bismuth (as Pepto-Bismol) 30 mL liquid or 2 tablets qid for 4 weeks plus metronidazole 250 mg qid for the first week, plus tetracycline 250 mg qid or amoxicillin 250 mg tid for 2-4 weeks
or
•"Dual therapy" with omeprazole 20 mg bid plus amoxicillin 500 mg qid for 2 weeks
•Short course therapy with 1 week of metronidazole, omeprazole, and clarithromycin bid - 90% effective
Contraindications: Hypersensitivity to the drug(s)
Precautions:
•If bismuth is prescribed, warn patient of black stools
•Refer to manufacturer's profile of each drug
Significant possible interactions: Refer to manufacturer's profile of each drug
For Herbal
curcuma longa
conteint: Azadichrain, asetiloksifuranil dekahidroterametil, oksiklopentanatolfuran asetat
farmacology, anti diabetic, anti diarchea, anti piretic, anti dispepsia
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