Got that gassy feeling?

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Gastritis is not as harmless as one might think

Gastritis is an inflammation, irritation, or erosion of the lining of the stomach. It can occur suddenly, in which case it is referred to as acute gastritis or gradually, when it is referred to as chronic gastritis. Excessive alcohol intake, chronic vomiting, stress, or the use of certain medications such as aspirin or other anti-inflammatory drugs can bring about gastritis by causing irritation in the lining of the stomach. If the condition is not treated, the patient could be running the risk of developing stomach cancer, severe loss in blood and other complications. In an interview with the Daily FT, Consultant Physician, Gastroenterologist and Endoscopist Dr. Upali Weragama shared some vital information about gastritis and complications that may arise from it. Dr. Weragama let us observe him performing an endoscopy to help us understand in greater depth how the procedure is carried out and the benefit and accuracy involved in using the endoscope. While he was performing the endoscopy we had the opportunity to see the inside of the patient’s stomach. There were delicate pink tissues with patches of inflamed tissues, which he pointed out to us so we could understand the difference between healthy tissue and inflamed tissue. He explained that the endoscopy shows clearly that the patient has an inflammation on the lining of the stomach as indicated by the very vivid patches of inflamed tissue. After the endoscopy he sat down with us and gave an in-depth lesson on gastritis, briefing us on when to be alarmed and when not to be, depending on the symptoms. He also cautioned us that dyspepsia, ulcers and other medical conditions can be mistaken for gastritis. Identifying and analysing symptoms can be tricky and so it is often advisable to seek the advice of a doctor. Following are excerpts of the interview:

Consultant Physician, Gastroenterologist and Endoscopist Dr. Upali Weragama

Q: What is gastritis? A: The general definition is it is an inflammation of the inner lining of the stomach. ‘Itis’ is a Latin word that means inflammation. When it is added as a suffix to the name of a particular organ it indicates an inflammation of that organ. For example the word ‘gastr’ is an ancient Greek word that means stomach, so gastritis means inflammation of the stomach; similarly ‘hepat’ means liver so hepatitis means inflammation of the liver and appendicitis means inflammation of the appendix. Q: What are the signs and symptoms? A: Symptoms vary and are basically what the patient tells us. The main symptom is pain in the upper abdomen, an early sense of fullness (early

satiety), nausea, heartburn or they could have bloating and pain brought about by certain food such as chilli and other spicy food. People with gastritis and people with stomach ulcers and other illnesses may have similar symptoms. The liver, gall bladder and pancreas are all organs that are positioned very close to each other. Hence a person with cancer in the gall bladder might have symptoms such as upper abdomen bloating which the patient just might take for gastritis. Q: What are the most common causes of gastritis? A: This could be broadly divided into three groups. There are three common causes:

Toxins and certain chemicals found in food and beverages that we consume such as alcohol, spicy food such as chilli and oily food.
Drugs; certain medicines especially painkillers. Steroids too can cause this. There are lots of medicines that cause an inflammation in the lining of the stomach.
There is an in infection called – ‘Helicobacter pylori’ (H. pylori). It is quite common in this part of the world. This occurs when the person ingests contaminated food or beverages. It is one of the leading causes of gastritis especially in the developing countries.

In addition to these there are rare causes but these are the three main causes.

Q: Some people feel discomfort after eating a particular kind of food. When they feel that discomfort, they say they are allergic to that food. Is it correct to say that? How would they know that they are having an allergic reaction to that food and not gastritis? A: There are certain food items and beverages that can aggravate this inflammatory process (gastritis). Spices and alcohol for example, can really aggravate the symptoms of gastritis. At the same time there could be other agents that could upset the stomach – if the person is intolerant to certain food and beverages then they get symptoms separately. This is what you call food allergy. These two are actually quite different. For instance if some people who claim they have gastritis are lactose intolerant and take milk the symptoms might in fact worsen. It is not due to gastritis. Normally people who have gastritis can expect some relief by drinking milk but some people can’t tolerate milk and dairy products not because of gastritis but because they are lactose intolerant or they may be allergic to proteins in milk. With that they could have bloating and other allergic symptoms. So those are two different entities. Q: That would be confusing to that person. How can he differentiate between the two? A: Exactly; so in that kind of situation they should seek advice and by doing additional tests we could differentiate whether its gastritis or whether it’s a food allergy. A gastroenterologist can differentiate that. Q: What is the method used to diagnose this condition? A: If we know the common causes then we can focus our investigations along those lines. For instance if we look at the history – when we talk to a patient and find that the patient eats a lot of spicy stuff then we can suspect that the problem is related to what he ingests. This isn’t always sufficient though as it depends on the particular case. Just by going by the history and not seeing the inner lining you can’t see what’s going on inside the stomach. For an accurate reading, a very good and highly recommended method used to diagnose gastritis is an endoscopy. Q: How is this endoscopy performed? A: A long, thin tube with a tiny camera at one end is inserted through the mouth into the stomach. With the help of this endoscope a doctor can see the state of the stomach and the stomach lining. We then check for inflammation. We might have to take a small tissue sample – what we call a biopsy and look at it under a microscope to find out the cause and extent of the ailment. Q: Is an endoscopy painful? A: There is minimum discomfort especially with new technology and techniques. Patients who are anxious are given the option of sedation. The most frequently used method of sedation for this is spraying the entrance of the throat. We use a local anaesthetic spray and this normally suffices. The other method is ‘conscious sedation’. Third is general anaesthesia. This is especially used for small children. It is when the person becomes unconscious. Q: Is endoscopy used only for diagnosis or can it can we use it for treatment as well? A: Endoscopy can be used for diagnostic purposes as well as for treatment. By the way, endoscopy is not just to detect gastritis. It can be used to detect and treat other ailments as well. It can be used to remove a foreign body, growth and tumours in the stomach; it can detect polyps that could grow into cancer. We can remove these polyps during endoscopy. Sometimes severe athritis with ulcer can bleed. We can stop bleeding by giving medication at the time of endoscopy. Endoscopy could be used for diagnosis as well as treatment or therapy at the same time. Q: Once diagnosed, what is the treatment given? A: Treatment can be broadly divided into two categories: The first is non-pharmacological; that is without medicine: This means lifestyle modifications and is very important. Lifestyle in terms of food and beverages, bad habits: alcohol, smoking and things like being overweight need to be changed. When it comes to risk factors – somewhere high up there are people who are overweight. People who are overweight or obese are prone to gastritis. So are people who smoke and drink alcohol. These are additional contributing factors. An effective way to battle gastritis would be weight reduction, a healthy diet and healthy habits. They should also avoid food that they have found to irritate their system. For example if they are lactose intolerant they have to stop consuming food and beverages that contain milk and other dairy products. The second category is medicine. These are:

Simple antacids to neutralise the acid. They can also be purchased over-the-counter.
Strong acid suppression medication to promote wound-healing. We can categorise them as H2 Blockers which include Cimetidine, Ranitidine and Famotodine. These are normally used to treat pregnant mothers.
There’s another potent group of medicines called Proton Pump Inhibitors (PPI) such as Omeprozole, Pantaprazole, Esomeprazole, Lansoprazole and Rabeprazole.

If they are infected by the Helicobactor Pylori they will have to be prescribed a 10 day – two weeks course of treatment with antibiotics, to eradicate the infection.

Q: Once cured what are the chances of recurrence? A: They have to maintain a healthy lifestyle to prevent recurrence. It must be strongly noted that once the illness is eradicated they have to be careful with what they eat. For example with the infection Helicobacter Pylori – after we test for that during endoscopy and it turns positive, we have to give them antibiotics to completely cure them. But after being cured if they continue to eat and drink the same muck then they can get re-infected. Q: Some people purchase over-the-counter medication each time they get this discomfort and it relieves the symptoms. But when they eat that same kind of food later they get the same discomfort and they run to the pharmacy again. Is it ok that they just keep doing that? A: No. Maybe on one or two occasions they can do that but if this becomes habitual and needing to take more and more medicine then that’s the time that they should seek advice. If it’s just a mild incidence and they know the cause such as spicy food they can do this. They can also drink milk-based products because milk can neutralise acid in the stomach. They don’t have to worry and rush to a doctor at the first signs of mild stomach discomfort. It’s especially so with young people in their 20-30s; when they get slight stomach discomforts, if it’s an obvious reason such as after drinking alcohol or after taking heavy painkillers, there’s no need to rush to a gastroenterologist. Then they can try some home remedies or over-the-counter medicines. If things are not settled or if it recurs frequently it is better to seek a doctor’s advice because it may not be mild gastritis; it could be or something else like dyspepsia, ulcers or even cancer. People above 40-45 should take extra precaution when experiencing gastric symptoms; if they have symptoms even for the first time and if these are unexplained symptoms it would be worthwhile to see a doctor because that is the time or age when you expect more problems. We have had cases with patients just taking treatment for months or years from pharmacies, nearby GPs or small medical centres for relief and when they finally come to us sometimes we have found that they have cancer in the stomach. There are red signs that one has to look out for regardless of age:

Vomit blood
Swallowing difficulties
Loss of appetite
Loss of weight

One of the most important take home messages here is that there are two clear ends. On the one side you don’t have to rush or be alarmed for trivial symptoms and can try home remedies but on the other side, if not relieved by remedies that we discussed, we have to be cautious of the possible dangers and at any age, look out for those symptoms that I categorised. Pix by Lasantha Kumara

Dyspepsia versus gastritis

Symptoms of dyspepsia and gastritis seem to overlap and therefore can be confusing. Owing to their common characteristics, people often mistake dyspepsia for gastritis and vice versa. Dyspepsia is a condition in which the gastrointestinal organs, primarily the stomach and first part of the small intestine, function abnormally. It is characterised by pain or discomfort in the upper abdomen, nausea, loss of appetite, feeling of unusual fullness after eating just a small portion of food, regurgitation of food or acid, belching, burning, heartburn, nausea and gaseous eructation. All these symptoms appear following a meal and are a result of difficulty in digesting food. It is not a disease but a group of symptoms that one experiences and can be mistaken for gastritis as the symptoms are very similar. The symptoms fluctuate in frequency and intensity. It may also be a sign of an underlying intestinal disorder such as peptic ulcer, gall bladder disease, or chronic appendicitis. Symptoms usually increase in times of stress. Dr. Upali Weragama believes it is more appropriate to use the term dyspepsia rather than gastritis when dealing with a patient who suffers from stomach discomfort. He says dyspepsia is an umbrella term used for symptoms including gastritis. “Dyspepsia comes with a lot of additional issues, whereas gastritis refers to just that one thing – the inner lining of the stomach is inflamed,” he says. “By definition gastritis is just that but used as a very loose term. A better word is dyspepsia which would encompass the same features of gastritis also.” “I must stress here that people might be having dyspepsic symptoms related to gastritis; in fact they might be having gastritis but we have to focus on a broader terminology and find out if it is in fact really gastritis or something else like a life-threatening cancer, especially in the old age group,” he added. The ideal way of establishing that it is gastritis, he says, is we have to test it; we have to do an endoscopy and perhaps do a biopsy and finally confirm whether or not it is in fact gastritis. We can then rule out dyspepsia or other ailments.

Dr. Weragama performing an upper gastrointestinal endoscopy

Dr. Weragama points out that the liver, gall bladder and pancreas are all organs that are positioned very close to each other. Hence a person with cancer in the gall bladder might have symptoms such as upper abdomen bloating which the patient just might take for gastritis