BRIEF RESUME OF INTENDED WORK:

NEED FOR STUDY:

Diseases and illnesses of the gastrointestinal system have grown in the last decade due to considerable lifestyle changes. People with gastrointestinal diseases have a high prevalence of depression, stress, anxiety, and impaired central nervous system functioning. ⁽¹⁾

Various etiological factors in eating habits and lifestyle, as smoking, alcoholism, anxiety, stress, associated diseases and inadequate nutrition, interact to the onset of clinical manifestations, and the presence and absence of H. Pylori did not show significant changes in patient clinical status. ⁽²⁾

In India gastritis is seen in 3 out of 869 persons, with around 12,25,614 people being affected out of the entire population of the country and the male-to- female ratio of gastritis affected people is 1:1. The prevalence of gastritis is 87% in 10-19 years of age. Sero-prevalence studies from Delhi, Mumbai, and Hyderabad show that by 10 years of age 50%, and by 20 years more than 80% of the population is infected with gastritis. The incidence rate of gastritis in the USA is 313,000. Worldwide prevalence is 2.7 million people. ⁽³⁾

Homeopathy places a greater emphasis on the whole person rather than just the ailment. The four guiding principles of homoeopathy form its core. These fundamentals have not changed in the past 200 years. "Like Cures Like" is the guiding philosophy. The word "Homoeopathy" actually comes from the greek words "Homoeo" and "Pathos," which both mean "alike" and "suffering," respectively. Each person has physical, mental, and spiritual symptoms when they are ill. Some of these signs are typical of the illness, while others are peculiar to the individual. The homoeopathic practitioner pays special attention to those symptoms that are specific to each person as they match the symptom image of the homoeopathic treatment to the symptom picture of the individual. The single remedy is the second axiom of homoeopathy. At any one time, just one homoeopathic medicine is administered. "Minimum Dose" is third principle. Individuals frequently experience side effects or unpleasant responses when taking drugs in adequate doses. The smallest dose possible is given by the homoeopath to enhance results and reduce undesirable consequence. "Potentized Remedy" is the fourth tenet of homoeopathy. Homeopathic medicines are produced differently from other medicines, even though they are generated from natural materials like plants, minerals, etc. The Aim of homoeopathic medicine for gastritis is not only to treat gastritis but to address its underlying cause and individual human.

REVIEW OF LITERATURE:

GASTRITIS

1.     Defination – Gastritis is inflammation of the gastric mucosa. It can be acute or chronic. ⁽⁴⁾

2.     Classification

A.  Acute Gastritis.

·       Acute helicobacter pylori infection

·       Other    acute    infection    gastritides    -    bacterial,            phlegmonous, mycobactrial, syphilitic, viral, parasitic, fungal, helicobacter heilmanni

·       Aspirin, alcohol, nsaids. ⁽⁵⁾

B.  Chronic Atrophic Gastritis.

·       Type A – Autoimmune – body predominant

·       Type B – H.Pylori related – antral predominant

·       Indeterminate

C.  Uncommon Form of Gastritis.

·       Lymphocytic

·       Eosinophilic

·       Crohn’s disease

·       Sarcoidosis

·       Isolated granulomatous gastritis

·       Russell body gastritis ⁽⁶⁾

3. Pathogenesis.

A. Acute gastritis.

The most common causes of acute gastritis are infectious. Acute infection with

h. Pylori induces gastritis. However, gastritis has not been extensively studied. It is reported as presenting with sudden onset of epigastric pain, nausea, and vomiting, and limited mucosal histologic studies demonstrate a marked infiltrate of neutrophils with edema and hyperemia.

Bacterial infection of the stomach or phlegmonous gastritis is a rare, potentially life-threatening disorder characterized by marked and diffuse acute inflammatory infiltrates of the entire gastric wall, at times accompanied by necrosis. Elderly individuals, alcoholics, and aids patients may be affected. Potential iatrogenic causes include polypectomy and mucosal injection with india ink. Organisms associated with this entity include streptococci, staphylococci, escherichia coli, proteus, and haemophilus species.

B. Chronic gastritis.

Chronic gastritis is identified histologically by an inflammatory cell infiltrate consisting primarily of lymphocytes and plasma cells, with very scant neutrophil involvement.

The early phase of chronic gastritis is superficial gastritis. The inflammatory changes are limited to the lamina propria of the surface mucosa, with edema and cellular infiltrates separating intact gastric glands. The next stage is atrophic gastritis. The inflammatory infiltrate extends deeper into the mucosa, with progressive distortion and destruction of the glands. The final stage of chronic gastritis is gastric atrophy. Glandular structures are lost, and there is a paucity of inflammatory infiltrates.

Type A Gastritis - The less common of the two forms involves primarily the fundus and body, with antral sparing. Traditionally, this form of gastritis has been associated with pernicious anemia in the presence of circulating antibodies against parietal cells and intrinsic factor; thus, it is also called autoimmune gastritis.

Type B Gastritis - Type B, or antral-predominant, gastritis is the more common form of chronic gastritis. H. pylori infection is the cause of this entity. Although described as antral-predominant, this is likely a misnomer in view of studies documenting the progression of the inflammatory process toward the body and fundus of infected individuals.

Miscellaneous Forms of Gastritis - Lymphocytic gastritis is characterized histologically by intense infiltration of the surface epithelium with lymphocytes. Marked eosinophilic infiltration involving any layer of the stomach (mucosa, muscularis propria, and serosa) is characteristic of eosinophilic gastritis. Several systemic disorders may be associated with granulomatous gastritis. Other unusual causes of this form of gastritis include sarcoidosis, idiopathic granulomatous gastritis, and eosinophilic granulomas involving the stomach.

(6)

4.    Clinical Features.

·       In acute gastritis epigastric discomfort, anorexia and nausea may be present. ⁽⁷⁾

·       H pylori–associated chronic gastritis may remain asymptomatic and gradually progress to severe complications such as gastric cancer. However, the rate of progression is highly unpredictable. ⁽⁸⁾

·       Due to the high prevalence of dyspeptic symptoms worldwide, it is essential to interpret them cautiously. Certain studies suggest that

dyspeptic symptoms, such as early satiety and postprandial fullness, may correlate with autoimmune gastritis, particularly in younger patients

without anemia or a smoking history or who are not currently smoking.

(8)

5.    Diagnosis.

·       Complete blood count.

·       An upper gastrointestinal endoscopic evaluation and a comprehensive histological examination of biopsy samples collected during the endoscopy. ⁽⁸⁾

·       The urea breath test and the h pylori stool antigen test are suggested for this assessment. ⁽⁸⁾

·       In addition, further serological testing to assess the presence of anemia resulting from vitamin b-12 and iron deficiencies is advisable. ⁽⁸⁾

6.     Differential Diagnosis.

·        Functional dyspepsia

·        Peptic ulcer disease

·        Gastric cancer

·        Cholecystitis

·        Zollinger-Ellison syndrome

·        Pancreatitis

·        Myocardial ischemia

·        Gastric lymphoma

·        Celiac disease ⁽⁸⁾

7.    Complication.

·       H pylori–induced gastritis can lead to various conditions, including peptic ulcer disease, idiopathic thrombocytopenic purpura, iron- deficiency anemia, and vitamin B12 deficiency.

·       Gastric cancer represents the most severe complication of atrophic gastritis.

·       Gastric neuroendocrine tumor represents another known complication of atrophic gastritis. ⁽⁸⁾

8.    Treatment.

·       Treatment of acute gastritis includes omission of the offending agent, acid-suppressive agents such as H2 receptor antagonists and proton- pump inhibitors, prostaglandin analogues such as misoprostol (more useful for prevention) and cytoprotective agents, such as sucralfate. ⁽⁷⁾

·       Treatment in chronic gastritis is aimed at the sequelae and not the underlying inflammation. Patients with pernicious anemia will require parenteral vitamin B12 supplementation on a long-term basis. Eradication of H. pylori is often recommended even if peptic ulcer disease or a low-grade mucus associated lymphoid tissue lymphoma is not present. Expert opinion suggests that patients with atrophic gastritis complicated by intestinal metaplasia without dysplasia should undergo surveillance endoscopy every 3 years. ⁽⁶⁾

9.    Diet and Regimen.

Food that should avoid.

Decaffeinated coffee, Drinks that contain alcohol, Spicy or strongly flavored cheeses, such as jalapeno or black pepper Highly seasoned, high-fat meats, such as sausage, salami, bacon, ham, and cold cuts Hot chiles and peppers.

Food That Are Recommended

Eat a variety of healthy foods from all the food groups. Eat fruits, vegetables, whole grains, and fat-free or low-fat dairy foods. Whole grains include whole- wheat breads, cereals, and brown rice. Choose lean meats, poultry (chicken and turkey), fish, beans, eggs, and nuts. ⁽⁹⁾

Homoeopathic Approach.

Most of the cases of gastritis have psychosomatic origin due to life style changes now a days.

As Dr. Clarke has said, “When the mind is ill at ease the stomach cannot work as it ought, and the face grows haggard and lean and the muscles lax. Worry is one great cause of indigestion”. ⁽¹⁰⁾

Some of homoeopathic remedy which are much important for treatment of gastritis from source book like. Homoeopathic Therapeutics by Dr. Samuel Lilienthal and Boericke’s New Manual of Homoeopathic Materia Medica Are as under.

1.   Arsenicum Album: Sub acute gastritis. ⁽¹¹⁾ Gastralgia from slightest food. Ill effects of vegetable diet, melons, and watery fruits generally. Fear fright and worry. Aggravation – cold food and drinks, wet weather, amelioration – heat, warm drink. ⁽¹²⁾

2.   Kalium Bichromicum: Vomited matter, sour, mixed with clear mucus or bitter from admixture of bile, renewed by every attempt of eating or drinking with great distress and burning rawness about stomach, pain and uneasiness in stomach alternating with pains in limbs. ⁽¹¹⁾

3.   Carbo Vegetabilis: Eructation, heaviness, fullness, and sleepiness. Digestion slow. aggravation – fat food, butter, coffee, milk, wine. amelioration – eructation and fanning. ⁽¹²⁾ The most innocent food causes excessive accumulation of gas in the stomach. ⁽¹¹⁾

4.   Robinia Pseudacacia: Gastric symptoms with most pronounced acidity are well authenticated. Intensely acrid eructation, acidity in children. ⁽¹²⁾

5.   Nux Vomica: Bitter or sour taste. Sour belching, fullness and pressure in the stomach. ⁽¹¹⁾ Nausea, vomiting with flatulence, ravenous hunger about day before an attack of dyspepsia. Desire stimulants, loves fate and tolerates them well. Dyspepsia from drinking strong coffee. Aggravation – eating, spices, stimulants. Amelioration – nap, hard strong pressure. ⁽¹²⁾

6.   Iris Versicolor: Burning in entire alimentary canal, vomiting, nausea, deficient appetite. Aggravation – evening, night, rest. amelioration – continue motion. ⁽¹²⁾ Great burning distress in epigastrium. ⁽¹¹⁾

7.   Anacardium Orientale: Weak digestion with fullness and distention. empty feeling in stomach. Eructation, nausea, vomiting. Eating relives the dyspepsia. They have a type of nervous dyspepsia. Aggravation – on application of hot water, amelioration – from eating. ⁽¹²⁾

8.   Mezereum: Desire for ham fat, burning in the tongue, extending to the stomach. mouth water. Nausea felt in throat better by eating. Chronic gastritis with burning, corroding pain, nausea, vomiting, chocolate color. Aggravation – warm food, night, evening. Amelioration – open air. ⁽¹²⁾

OBJECTIVE OF THE STUDY:

1.     To study Gastritis etiology, clinical presentation and management (medicinal and lifestyle management).

2.     To know the role of homoeopathic medicine in treatment and management of gastritis.

MATERIAL AND METHODS:

SOURCES OF DATA:

Project site – C.D. Pachchigar College of Homoeopathic Medicine and Hospital; Near Navjivan Circle, Udhana Magdalla Road, Surat- 395001.

MATERIALS:

1.     College OPD standard case taking format.

2.     Homoeopathic software CARA PRO version v 1.4, Synthesis by Dr. Frederik Schroyens, MD.

3.     Consent form of patient.

4.     Various books of Allied Science, Materia Medica and Organon.

METHOD OF COLLECTION OF DATA:

1.     Study design – Experimental study.

2.     Study type – Prospective study.

3.     Study population – cases having complain of gastritis treated with homoeopathic medicine at C.D. Pachchigar College of Homoeopathic Medicine and Hospital.

4.     Sample size – 30 cases.

5.     Sampling techniques - Simple randomization.

6.     Selection criteria.

Inclusion criteria.

1.     Patient of all age and both sex.

2.     Irrespective of socioeconomic condition and religion are included.

3.     Cases with functional changes and no structural changes.

4.     Cases which are diagnosed clinically according to history and sign and symptoms.

5.     Cases which are previously diagnosed by gastroenterologist.

Exclusion criteria.

1.     Critical emergency cases.

2.     All advanced pathological cases like gastric carcinoma or tumors which requires surgical intervention.

3.     Cases with coexisting severe systemic illness.

4.     Cases with irregular follow up and those patients who left treatment in between.

Response will Analysed as per following criteria’s:

1.     Improvement: patients relieved from presenting complaint in frequency and in intensity.

2.     No improvement: patients who didn’t get any relief in spite of giving medicines at regular interval.

- Follow up cases will be done at every 7,15,21,30 days as per requirement of case.

DOES THE STUDY REQUIRING ANY INVESTIGATION TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS?

As per requirement of the case

HAS ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR INSTITUTE?

YES