1. GASTRITIS AND IRRITABLE
BOWEL SYNDROME AND ITS
MANAGEMENT
-BY SHWETA SHARMA
M.SC. I YEAR
AIIMS, JODHPUR

2. INTRODUCTION
Gastritis is an inflammation,
irritation, or erosion of the lining
of the stomach. It is one of the
most common problems
affecting the stomach. It can
occur suddenly (acute) or
gradually (chronic).

3. EPIDEMIOLOGY
•In acute gastritis, the prevalence of eosinophilic gastritis is
approximately 6.3 per 100,000 individuals worldwide.
•The incidence of new cases of H. pylori infection each year
ranges from 3,000 to 10,000 per 100,000 individuals in
developing countries.
•It has been observed that with advancing age, the
incidence of H. pylori infection increases.
•In acute gastritis, females are usually more affected than
men.

4. ETIOLOGY
1. Drugs- NSAIDs, corticosteroids, etc.
2. Diet- Alcoholic drinking binge, large quantities of spicy, irritating
foods and metabolic conditions such as renal failure can also cause
acute gastritis.
3. Micro-organisms- Helicobacter pylori infection, Salmonella and
staphylococcus
4. Environmental factors- Radiation and smoking
5. Autoimmune gastritis- Autoimmune metaplastic atrophic
gastritis

5. 6. Other causes-
•Burns
•Large hiatal hernia
•Physiologic stress
•Psychologic stress
•Reflux of bile and pancreatic secretions
•Renal failure
•Sepsis
•Shock
•Endoscopic procedures
•Nasogastric tube

6. PATHOPHYSIOLOGY
Acute gastritis-
Due to any cause
↓
Gastric mucosal barrier is penetrated
↓
Hydrochloric acid comes into contact with the mucosa
↓
Injury to small vessels
↓
Oedema, haemorrhage, and possible ulcer formation

7. • Chronic gastritis-
The stomach lining first becomes thickened and erythematous and then
becomes thin and atrophic.
↓
Continued deterioration and atrophy
↓
Loss of function of the parietal cells
↓
Acid secretion decreases
↓
Inability to absorb vitamin B12
↓
Development of pernicious anemia

8. CLINICAL MANIFESTATIONS
Acute gastritis:
•Epigastric discomfort
•Feeling of fullness
•Abdominal tenderness
•Cramping
•Belching
•Anorexia
•Reflux
•Severe nausea and vomiting
•Hematemesis
•Sometimes GI bleeding is the only manifestation
•When contaminated food is the cause of gastritis, diarrhoea usually develops within 5 hours
of ingestion
Acute gastritis is self-limiting, lasting from a few hours to a few days, with complete healing of
the mucosa expected.

9. Chronic gastritis: Manifestations are vague and may be absent because the
problem does not cause an increase in hydrochloric acid.
•Anorexia
•Feeling of fullness
•Dyspepsia
•Belching
•Vague epigastric pain
•Nausea
•Vomiting
•Vitamin B12 deficiency
•Pernicious anaemia
•Intolerance of spicy and fatty foods

10. DIAGNOSTIC EVALUATION
1.History collection- Drug or alcohol abuse
2.Endoscopy
3.Complete blood count for anaemia
4.Tissue biopsy to rule out gastric carcinoma.
5.Urea breath test for helicobacter pylori infection

11. COMPLICATIONS
•Bleeding
•Pernicious anaemia
•Peptic ulcer
•Erosive stomach lining (the stomach tissue wears away)
•MALT (mucosa-associated lymphoid tissue) lymphoma
•Gastric scarring and strictures with outlet obstruction
•Dehydration
•Haemorrhage
•Gastric perforation
•Malnutrition
•Gastric cancer

12. MEDICAL MANAGEMENT
Acute gastritis:
•Anti - emetic drugs- Perinorm or Domperidone
•Antacids- cimetidine, ranitidine, or famotidine
•If ingestion of NSAIDs is a problem, a prostaglandin
E1 (PGE1) analog may be prescribed to protect the
stomach mucosa and inhibit gastric acid secretion.

13. Chronic gastritis:
• Discomfort may lessen with a bland diet, small frequent meals,
antacids, H2 receptor antagonists, proton pump inhibitors, and
avoidance of food that cause manifestations.
• If H. pylori bacteria are present, anti-biotics and other medications
are administered to eliminate the bacteria.
• If 1 week of this regimen does not succeed in eliminating the
bacteria, the regimen may be repeated for an additional week.
• If pernicious anemia develops, intramuscular injections of vitamin
B12 may be administered monthly for the remainder of the client’s
life.

14. SURGICAL MANAGEMENT
• Subtotal gastrectomy (for perforation or cancer)-A subtotal gastrectomy
includes removing the cancerous part of your stomach, nearby lymph nodes,
and possibly parts of other organs near the tumor.

15. • Pyloroplasty (for pyloric stenosis)-Pyloroplasty is surgery to
widen the opening in the lower part of the stomach (pylorus) so
that stomach contents can empty into the small intestine
(duodenum).

16. • Vagotomy-A vagotomy is a surgical procedure that involves
removing part of the vagus nerve. Vagotomy reduces gastric acid
secretion.

17. • Total gastrectomy (for cancer)- It is removal of the entire
stomach.

18. DIETARY MANAGEMENT
• Initially foods and fluids are withheld until nausea and vomiting
subside.
• Once the client tolerates food, the diet includes decaffeinated
tea, gelatin, toast, and simple bland foods.
• The client should avoid spicy foods, caffeine and large, heavy
meals.
• In the continued absence of nausea, vomiting and bloating, the
client can slowly return to a normal diet.

19. NURSING MANAGEMENT
1)Acute pain related to irritated stomach mucosa as evidenced by numerical
pain scale score.
Goal- Patient describes satisfactory pain control at a level less than 3 to 4 on a
rating scale of 0 to 10.
2)Imbalanced nutrition, less than body requirement, related to inadequate
intake of nutrition as evidenced by weight loss.
Goal-Patient will demonstrate behaviors, lifestyle changes to recover and/or
keep appropriate weight.
3)Risk for fluid and electrolyte imbalance related to insufficient fluid intake and
excessive fluid loss subsequent to vomiting.
Goal- The patient will be free from risk of imbalanced fluid volume.

20. 4)Anxiety related to treatment as evidenced by facial
expressions.
Goal- Patient identifies strategies to reduce anxiety.
5)Deficient knowledge related to disease process and
its dietary management as evidenced by frequent
questioning.
Goal- Patient will have adequate knowledge about
disease process and its dietary management.

21. IRRITABLE BOWEL SYNDROME
• Irritable bowel syndrome (IBS) is a
common gastrointestinal disorder
involving an abnormal condition
of gut contractions (motility) and
increased gut sensations (visceral
hypersensitivity) characterized by
abdominal pain / discomfort, gas,
bloating, mucous in stools, and
irregular bowel habits with
constipation or diarrhoea or
alternating diarrhoea and
constipation.

22. EPIDEMIOLOGY
•Inflammatory Bowel Syndrome affects around 11% of the
population globally.
•The disorder is usually found in the age group of 15–50 years and
may also occur in children and elderly.
•The prevalence of IBS in general population of India is 15%.
•It affects women 2 to 2.5 times more often than men.
•Men report manifestations of diarrhoea more commonly than
women.
•Women report manifestations of constipation more commonly
than men.

23. ETIOLOGY
1. Abnormal gastrointestinal (GI) tract movements.
2. A change in the nervous system communication between the GI and
brain.
3. Sensory and motor disorders of the colon.
4. Dietary allergies or food sensitivities.
5. Neurotransmitter imbalance (decreased serotonin levels).
6. Psychologic stressors (e.g. depression, anxiety, sexual abuse, post-
traumatic stress disorder)

24. TYPES OF IBS
1.Constipation-predominant: the person tends to alternate
constipation with normal stools.
Symptoms of abdominal cramping or aching are commonly
triggered by eating.
2.Diarrhoea-predominant: the person tends to experience
diarrhoea first thing in the morning or after eating. The need to
go to the toilet is typically urgent and cannot be delayed.
3.Alternating constipation and diarrhoea (IBS-A OR IBS-M)
mixed IBS

25. PATHOPHYSIOLOGY

27. CLINICAL MANIFESTATIONS
•Abdominal pain and discomfort
•Alterations in bowel pattern (diarrhoea or constipation)
•Abdominal distension
•Excessive flatulence
•Bloating
•Urgency and sensation of incomplete evacuation
•Fatigue and sleep disturbances

28. DIAGNOSTIC EVALUATION
• No clear diagnostic markers exist for IBS.
• So, diagnosis depends on positive clinical features and ruling out
diseases by careful clinical examination and investigations.
• History collection (including psychosocial factors such as stress and
anxiety)
• Physical examination
• Diagnosis can be made confidently in most patients using
Rome III criteria + absence of red flag signs + supportive symptoms
which include defecation straining, urgency or a feeling of
incomplete bowel movement, passing mucus and bloating.

29. ROME III CRITERIA

30. FLEXIBLE SIGMOIDOSCOPY

31. •CT scan
•X-ray- colonic spasm

33. RED FLAG SIGNS AND SYMPTOMS
Unintentional and unexplained wt. loss
Rectal bleeding
Family history of bowel/ovarian cancer
A change in bowel habit to lose and/or more frequent stools
persisting for more than 6 weeks in a person aged over 60yrs.
Anaemia
Abdominal mass
Rectal mass
Inflammatory markers for IBD

34. To rule out organic causes-
•Complete blood count
•Erythrocyte sedimentation rate
•C-reactive protein
•Stool examination for ova and parasites
•Antibodies for Coeliac Disease
•Sigmoidoscopy when more than 50 years/ red flag signs present
•Younger individual with mild symptoms – minimal diagnostic
evaluation,
•Older – undergo more thorough evaluations

35. MEDICAL MANAGEMENT
• Loperamide- a synthetic opioid that slows intestinal transit, may
be used to treat diarrhoea.
• Alosetron- a serotonergic antagonist, is used for IBS patients
with severe symptoms of pain and diarrhoea (drug should be
discontinued if patient develops severe constipation or ischemic
colitis).
• Lubiprostone- for constipation in women.
• Linaclotide- for constipation in men and women.
• Low doses of tricyclic antidepressants- to reduce peripheral
nerve sensitivity.

36. DIETARY MANAGEMENT
• Eliminate food stuffs that appear to produce symptoms.
• Consume high fibre diet for IBS-C.
• Exclude wheat, dairy and gluten –to avoid pain and bloating.
• Avoid common gas producing foods such as broccoli and cabbage.
• Yogurt may be better tolerated than milk products.
• Probiotics may be used because alterations in intestinal bacteria are believed to
exacerbate the condition. Examples of probiotics- Lactobacillus, Bifidobacterium,
Saccharomyces boulardii (yeast), etc.
• Avoid legumes and excess dietary fibre - IBS-D
• Diet low in FODMAPs (Fermentable Oligosaccharides, Disaccharides,
Monosaccharides and Polyols)
• FODMAPs are short chain carbohydrates poorly absorbed in small intestine and
fermented by bacteria in colon to produce gas

37. PSYCHOTHERAPY
•Psychological therapy is effective in two thirds of
patients with IBS who do not respond to standard
medical treatment
•Cognitive behavioral therapy
•Stress management techniques
•Acupuncture
•Hypnotherapy

38. PATIENT COUNSELLING
•Reassuring the patient is the most successful form of
treatment for IBS.
•Many are concerned that they have developed cancer –
more anxiety-more colonic symptoms.
•Explain functional nature of disorder and how to avoid
obvious food precipitants.
•Emphasize on expected chronicity of symptoms with
periodic exacerbations.

39. NURSING MANAGEMENT
• Reinforce the physician’s explanation of the nature of the disorder, the
intervention plan, and the prognosis.
• Make it clear to the client that the bowel responds to stress, foods, and
medications.
• Emphasize the importance of regular hours, nourishing meals, and
adequate sleep, exercise and relaxation.
• Help the client to establish a regular bowel routine.
• Advise the client with diarrhoea to limit foods that produce gas or irritate
the bowel and to avoid (1) caffeinated and carbonated beverages, (2)
alcohol, (3) foods containing indigestible carbohydrates, such as beans, and
(4) milk and milk products.
• Provide empathy and support.

40. RESEARCH ARTICLES
• 1.Dietary habits and Helicobacter pylori infection: a cross
sectional study at a Lebanese hospital
• A cross-sectional study was conducted on 294 patients in 2016, at a hospital in Northern
Lebanon. Participants were interviewed using a structured questionnaire to collect
information on socio-demographic and lifestyle characteristics; dietary habits were
ascertained via a short food frequency questionnaire (FFQ). H. pylori status (positive vs.
negative) was determined after upper GI endoscopy where gastric biopsy specimens from
the antrum, body, and fundus region were collected and then sent for pathology analysis.
Multivariable logistic regression was conducted to identify the association between socio-
demographic, lifestyle, dietary and other health-related variables with H pylori infection.
The prevalence of H. pylori infection was found to be 52.4% in this sample. Results of the
multivariable analysis showed that H. pylori infection risk was higher among participants
with a university education or above, those with a history of peptic ulcers, gastric
adenocarcinoma and vitamin D level below normal. In contrast, hyperglycaemia was
protective against H. pylori. No relationship between dietary habits and H. pylori
infection was found in the adjusted analysis. The study concluded that socio-
demographic and clinical variables were associated with H. pylori, but not with dietary
factors. Further studies are needed to investigate the effect of diet on H. pylori risk.

41. • 2. Epidemiology of Dyspepsia and Irritable Bowel
Syndrome (IBS) in Medical Students of Northern India
• A cross-sectional study was carried out from January to March 2014 at
Maulana Azad Medical College, New Delhi, India. A total of 210 students from
a Medical College were asked to complete a semi-structured questionnaire
based on identification and socio-demographic data, questions pertaining to
lifestyle and Rome III criteria. Majority of the subjects (diagnosed with
uninvestigated dyspepsia and IBS) were in the age group of 18-20 y with
female gender having higher odds for both. The prevalence of dyspepsia was
18% while that of IBS was 16.5%. Consumption of fatty food, cigarettes and
low physical activity were observed as most significant correlates. The study
concluded that Rome III criteria enables symptom-based diagnosis of
dyspepsia and IBS. The prevalence of dyspepsia and IBS in college students
from Delhi is observed to be higher. Association with lifestyle related factors
highlights the importance of modifications in their prevention.

43. CONCLUSION
• As discussed throughout the presentation, learning about
gastritis and irritable bowel syndrome and their management
will help nurses to care for patients of gastritis and irritable
bowel disease.
• Nurses can do assessment of patients with gastritis and
irritable bowel disease, observe the sign and symptoms,
provide the necessary nursing care and support the patient
psychologically.
• Nurses can also counsel the patients and their family for
various options available in treatment for gastritis and irritable
bowel syndrome.

44. REFERENCES
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