What is Antral Gastritis – All you need to know

What is Antral Gastritis?

Antral gastritis is the inflammation of the inner mucosal lining in the antral part of the stomach.

Antrum means the lower portion of the stomach.

This mucus-secreting protective layer in the inner side of the stomach wall prevents the stomach wall from corrosive acid, helping in our digestion process. When this protective layer is weakened or damaged due to inflammation of gastric mucosa, it is gastritis.

What are the different types and causes of Antral Gastritis?

Acute gastritis (often Erosive or Haemorrhagic gastritis) 

Here, due to inflammation, gastric mucosal erosion happens and is also accompanied by bleeding.

The different causes include,

• Chemical/drug-induced – mainly pain killer or Non-steroidal anti-inflammatory drugs (NSAIDs) or steroid-induced (seen in about 50% of cases)
• Corrosives – acid, alkali
• Alcohol-induced (seen in 20% of GI bleeding)    
• Severe stress secondary to past surgery, trauma, CVA, long bed-ridden conditions
• Portal hypertension with gastropathy, bile reflux
• Viral infection like Cytomegalovirus (CMV) and Herpes Simplex Virus (HSV) in AIDS.  

Chronic non–erosive gastritis

Here inflammation of the gastric mucosal layer happens without erosion. This may present with chronic gastritis too.

• Type A gastritis – This is an autoimmune gastritis involving fundal glands leading to Achlorhydria and vitamin B12 non absorption.

• Type B gastritis or Chronic Helicobacter Pylori gastritis – The causative agent is H Pylori, a gram negative bacteria  found in the gastric submucosal layer. The mechanism of injury is not clear, but frequent infection may cause chronic inflammatory changes and may culminate into complete atrophic gastritis. Sometimes, there may be metaplasia of gastric epithelium with 4–6 fold rise in incidence of Adenocarcinoma.  

This H pylori infection may give rise to peptic ulcers.

• Specific gastritis – This is caused due to result of any other specific disease like viral infection, granulomatous inflammation like Tuberculosis (TB), Crohn’s etc.

What are the presentations of Antral Gastritis?

The presentations of gastritis are listed below:

 The primary presentation of antral gastritis is a burning sensation in the epigastric area (upper mid-abdomen area).

• Upper abdominal pain, mainly in epigastrium
• Bloated distended abdomen
• Anorexia
• Maybe a stomach ulcer
• Nausea and vomiting, etc.
• In severe cases, may be bleeding, that is, hematemesis and melena in GI ulcer.

What are the tests required for diagnosing Antral Gastritis?

The following tests are performed for diagnosing Antral Gastritis,

• Blood examination may show Anaemia in chronic bleeding ulcer cases

• Key investigation is Upper GI endoscopy plus/minus biopsy for H Pylori

• Urea breath test

• USG abdomen, if associated with biliary pathology

What are the possible complications of Antral Gastritis? 

The possible complications of Antral Gastritis, if not treated properly, include,

• H Pylori can cause stomach ulcers that can bleed, leading to Anaemia.

• Autoimmune gastritis induced vitamin B12 malabsorption can lead to Pernicious anaemia.

• Chances of occurrence of Gastric cancer. 

What are the treatments for Antral Gastritis?

The treatment is based on two aspects,

• Diet and lifestyle changes and

• Specific medications

The treatment is based on two aspects,

What are the diet/lifestyle advices for antral gastritis?

The diet/lifestyle advices for Antral Gastritis includes:

• Avoid spicy and hot foods and long time fasting.
• Eat small frequent meals. In the diet, lactose or gluten is to be avoided.
• Also, avoid fried and acidic foods,
• Relaxation exercises to de-stress are very important.
• Avoid excess tea/coffee.

What are the different types of medicines used?

Different medications for Antral Gastritis includes:

• Antacids may be taken to neutralize preformed acid.
• H2 blockers (Ranitidine, Cimetidine) and PPI (Omeprazole, Pantoprazole, Esomeprazole, etc.) to stop further acid production.
• NSAID induced gastritis may be treated with Sucralfate.
• Anti H Pylori kit with triple drugs like PPI/Metronidazone/Clarithromycin or amoxycillin to be used as per doctor’s advice.
• Vitamin B12 to be taken in malabsorption in gastritis.

Conclusion

Thus, the symptoms of Antral Gastritis may be mild and may also be severe if untreated. It is really important to consult a doctor, even in case of mild symptoms, for proper dietary and medicinal advice. If any other background disease is present, that needs to be examined and treated accordingly.