Gastritis is simply the inflammation of the gastric mucosa, the protective inner lining of the stomach. Under normal conditions, this lining produces a thick layer of mucus containing bicarbonate, which shields the stomach wall from its own powerful hydrochloric acid and digestive enzymes like pepsin. When this defensive mucosal barrier breaks down, gastric acid diffuses back into the tissue layers. This back-diffusion causes cellular injury, local vasodilation, edema, and bleeding, leading to the clinical picture of gastritis. The two main culprits behind this barrier breakdown are *Helicobacter pylori* infection and the regular use of non-steroidal anti-inflammatory drugs (NSAIDs). *H. pylori* bacteria burrow into the mucous layer and produce urease, an enzyme that neutralizes stomach acid around them while destroying mucosal cells. NSAIDs, frequently taken for aches and pains in Nigerian communities, block prostaglandins—substances that normally stimulate the production of the protective mucus layer. Once this defense fails, even normal amounts of stomach acid begin to eat away at the stomach tissue.
Gastritis presents in two main forms based on how quickly it develops and how long it lasts: acute and chronic.
In many Nigerian hospitals, patients often present with acute flare-ups triggered by prolonged fasting, heavy use of local herbal mixtures containing harsh ingredients, or continuous self-medication with strong analgesics for malaria-related joint pains.
The clinical presentation of gastritis varies depending on whether the inflammation is sudden and sharp or long-standing. Many patients with chronic forms may actually have very few symptoms, while acute cases can cause sharp discomfort.
Common signs and symptoms include:
During assessment, the midwife must ask detailed questions about the patient's diet, medication history, alcohol use, and stress levels. Palpation of the abdomen may reveal mild tenderness in the epigastric region. If bleeding occurs due to mucosal erosion, the patient might vomit blood, known as hematemesis, or pass dark, tarry stools called melena, signaling upper gastrointestinal bleeding.
While a thorough clinical history helps suspect gastritis, definitive diagnosis often requires specific investigations. The gold standard for diagnosing gastritis is an upper gastrointestinal endoscopy (esophagogastroduodenoscopy or EGD). During this procedure, a flexible lighted tube with a camera is passed through the mouth down into the stomach, allowing the doctor to visually inspect the mucosal lining. The lining often appears red, swollen, and sometimes shows erosions or small bleeding spots. During the endoscopy, small tissue samples or biopsies can be taken.
These biopsy samples are crucial because they can be tested directly for the presence of *H. pylori* using a rapid urease test or sent to the laboratory for microscopic examination. Other supportive tests include stool antigen tests, urea breath tests to check for bacterial presence without an endoscopy, and a complete blood count to check for anemia if chronic blood loss has occurred.
Medical treatment for gastritis focuses on removing the underlying cause, reducing gastric acidity, and protecting the damaged mucosal lining. When *H. pylori* is detected, doctors prescribe a combination regimen known as triple therapy, which usually includes a proton pump inhibitor and two different antibiotics taken for 10 to 14 days.
Several classes of medications are used to manage symptoms and promote healing:
Patients are also advised to avoid irritating substances such as alcohol, spicy foods, caffeine, and unnecessary NSAIDs during treatment.
Midwives play a vital role in caring for hospitalized patients with severe gastritis and educating those being discharged. The nursing care plan begins with assessing pain levels and administering prescribed anti-emetics and antacids promptly. During acute episodes, the patient may need temporary fasting to let the stomach rest, followed by a gradual introduction of bland, easily digestible foods like plain porridge, yam, or rice.
Patient education is essential for long-term recovery and preventing recurrence. Midwives should counsel patients to:
If left untreated or improperly managed, chronic or severe acute gastritis can lead to serious complications. The continuous erosion of the mucosal barrier can deepen into peptic ulcers, which may bleed profusely or even perforate the stomach wall, spilling gastric contents into the abdominal cavity and causing peritonitis. Another long-term complication of chronic atrophic gastritis is pernicious anemia, which occurs because damaged parietal cells can no longer produce intrinsic factor, a substance vital for absorbing vitamin B12 in the small intestine.
Midwives must remain vigilant for emergency warning signs that require immediate medical intervention. These include sudden, severe abdominal pain, persistent vomiting of blood, or signs of hypovolemic shock such as a rapid, weak pulse, cold clammy skin, and dizziness, which indicate significant internal bleeding.