Acute vs Chronic Gastritis | Chronic Gastritis vs Acute Gastritis Causes, Symptoms, Diagnosis and Management
Gastritis is the inflammation of the gastric mucosa. It is basically a histological diagnosis, although it is sometimes been recognized at upper gastro-esophageal endoscopy (UGIE). According to the onset of the disease process, it is categorized as acute and chronic gastritis. This article points out the differences between acute and chronic gastritis with regard to the definition, temporal relationship, etiology, macroscopic and microscopic changes, clinical features, complications and management.
It is the acute inflammation of the mucosa of the stomach, which is often erosive and hemorrhagic. The common causes involved are use of non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, exposure to direct acting luminal chemicals such as alcohol, stress such as severe burns, myocardial infarction, and intra cranial lesions and during postoperative period, chemotherapy and ischemia.
Endoscopically it is characterized by diffuse hyperemia of the mucosa with multiple, small, superficial erosions and ulcers. Microscopy reveals surface epithelial injury and denudation and variable necrosis of the superficial glands. Hemorrhage in to the lamina propria may be seen. Inflammatory cells are not present in large numbers, though, the neutrophils are the predominant.
In mild cases, patients are usually asymptomatic or may have mild dyspeptic symptoms. In moderate to severe cases, patient presents with epigastric pain, nausea, vomiting, haematemesis and melena. In severe cases patient may have developed deep ulceration and perforations as complications.
Management of acute gastritis mainly directed to the underlying cause. Short term symptomatic therapy with antacids and acid suppression with proton pump inhibitors or antiemetics may be necessary.
It is defined histologically as an increase in the number of lymphocytes and plasma cells in the gastric mucosa. According to the etiology it is categorized as type A, which is of autoimmune in origin, type B is caused by Helicobacter pylori infection, and there a few causes of neither type whose etiology is unknown.
Endoscopically, mucosa may appear to be atrophied. Microscopy reveals lympho-plasmatic infiltrate in the mucosa around the parietal cells. Neutrophils are rare. Mucosa may show changes of intestinal metaplasia. At the end stage, mucosa is atrophied with absent parietal cells. In H.Pylori infection, the organism may be noted.
Most patients with chronic gastritis are asymptomatic. Some patients may present with mild epigastric discomfort, pain, nausea and anorexia. On endoscopic examination, there may be no features or loss of normal rugal folds may be noted. Since these patients have an increased risk of gastric carcinoma, screening endoscopically may be appropriate. Patients with type A gastritis may have evidence of other organ specific autoimmunity specially thyroid disease.
As most of the patients are asymptomatic, they do not need treatment. Patients with dyspepsia may be benefited from H. pylori eradication.
What is the difference between acute gastritis and chronic gastritis?
• Acute gastritis is often erosive and hemorrhagic but chronic gastritis is not.
• NSADs and alcohol are the common causes of acute gastritis while autoimmunity and H Pylori are the common causes of chronic gastritis.
• Endoscopically inflammatory changes are seen only in acute gastritis.
• Neutrophils are the predominant inflammatory cell in acute gastritis while lympho-plasmatic infiltration is seen in chronic gastritis.
• Chronic gastritis has an increased risk of gastric carcinoma, especially type A, which is considered as pre malignant.