Alcoholic Gastritis

Abstract

Gastritis is inflammation of the gastric mucosa. Alcohol ingestion may lead to an acute hemorrhagic or erosive gastritis through direct irritation of the gastric mucosa. Alcohol also leads to increased gastrin production and decreased pepsin secretion,which can cause gastric irritation. Endoscopy performed on healthy adults after direct ingestion of alcohol shows gastric hyperemia and erosions. Although alcohol-related gastritis most often is asymptomatic, it also may present with epigastric or upper abdominal pain, nausea, vomiting, and massive or occult gastrointestinal bleeding. In adults, alcohol use is a common cause of erosive gastritis, but nonsteroidal anti-inflammatory drug use is the most common cause. The incidence of alcoholic gastritis has not been identified in children and adolescents.Chronic antral inflammation frequently is observed in adult alcoholics. However, it is not clear whether this condition is a result of alcohol use, Helicobacter pylori, or their interaction. One study examined alcoholic patients who had gastritis after abstinence and then compared treatment for H pylori with antacid therapy. Neither abstinence from alcohol alone nor antacids was successful in improving gastritis. However, eradication of the H pylori cleared the gastritis. Ongoing animal studies also seem to confirm the presence of damaging interactions between H pylori and alcohol.Gastritis is neither common nor extensively studied in adolescents. As in adults, H pylori has been shown to be a causative agent, when present, in ulcer disease and gastritis in children and adolescents. Similarly, agents shown to be toxic in adults (such as alcohol) are at least as toxic in adolescents and children. Identification and treatment of alcoholic gastritis is important for several reasons: 1) chronic gastritis and ulcer disease increase future cancer risk; 2) gastritis can lead to life-threatening gastrointestinal bleeding; and, perhaps most important for adolescents, 3) identification of alcohol use should lead to interventions to decrease the morbidity and mortality associated with alcohol use and abuse.Alcohol use is a major problem among youth. Average age for first time use is 11.9 years for males and 12.7 years for females. Recent heavy drinking (defined as five or more drinks in a row in the past 2 weeks) has been reported by 15% of eighth graders, 24% of tenth graders, and 40% of college students. Parents often underestimate whether their children drink alcohol. Additionally,the physical indicators of alcohol or drug abuse seen in adults often are not seen in children; behavioral changes are more common indicators in youth.With the high prevalence of alcohol use among adolescents, it is important to question all adolescent patients about it. Current preventive services guidelines for adolescents recommend annual screening for alcohol use and counseling on its dangers, with a special emphasis on drinking and driving. Systematic screening about alcohol use at health super-vision visits provides an important opportunity to educate about and help prevent adolescent substance abuse. Special care should be taken to ask about alcohol use when adolescents present with abdominal symptoms, whether acute or chronic. Although not the most frequent cause of abdominal symptoms or of gastritis in adults or children, alcohol-related gastritis will not resolve until the offending agent is removed.Asking adolescents who have symptoms of gastritis about alcohol use is critical. Understanding the cause of the gastritis provides an opportunity to address the root of the problem—alcohol. Among adolescents, identification of alcohol use and alcohol-related morbidity and counseling on healthy behavior may influence lifelong health practices. This diagnosis can provide a window of opportunity.