Stomatitis is the inflammation of mouth and is caused by bacterial, viral and fungal infections in persons with poor oral hygiene or in blood dyscrasias
Causes of Stomatitis :
a. Local Causes: Poor oral hygiene, excessive use of tobacco, alcohol and spices, use of broad spectrum antibiotics and drugs such as iodine or gold.
b. General Causes: The main general causes are the infectious diseases. There are various types of infective stomatitis:
1. Bacterial, e.g. streptococcal stomatitis and Vincent’s stomatitis
2. Viral, e.g. Herpes simplex and herpes zoster
3. Fungal, e.g. candidiasis and actinomycosis
4. Recurrent aphthous stomatitis
5. Mucocutaneous diseases, e.g. Lichen planus, pemphigus vulgaris, lupus erythematous, etc.
6. Miscellaneous, e.g. diabetes, uremia and ‘drug toxicity.
Treatment :
The general treatments for stomatitis are:
a. Elimination of causes.
b. Alkaline mouthwash.
c. Vitamin B complex.
Clinical Features :
-Lip, tongue and gums are inflamed, swollen and painful.
– Tongue is furred and foul smell is present.
-Sometimes ulceration of mucus membrane is present when person is suffering from infectious stomatitis
-Patient feels pain and difficulty in opening the mouth.
– There was an excoriation and redness of mucus membrane of oral cavity.
Diagnosis :
1. Blood Picture
-Leucocytosis
-Anemia
2. Endoscopy
3. Barium meal study.
Treatment of Acute Gastritis :
-Stop taking NSAIDs or alcohol.
-H2, blockers ranitidine 300 mg should be started. It improves healing.
– More potent agent omeprazole or other proton pump inhibitor can be given for more rapid relief.
-Tell the patient not to take the drug empty stomach
-Switch over to selective “COX-2 inhibitor if analgesics are really needed. Valdecoxib or etoricoxib can be prescribed.
In mild cases antacids 30 ml 4.6 hourly c2. Endoscopy
3. Barium meal study.
Treatment of Acute Gastritis
Stop taking NSAIDs or alcohol.
H, blockers ranitidine 300 mg should be started. It
improves healing.
– More potent agent omeprazole or other proton pump inhibitor can be given for more rapid relief.
Tell the patient not to take the drug empty stomach Switch over to selective “COX-2 inhibitor if analgesics are really needed. Valdecoxib or etoricoxib can be
prescribed.
-In mild cases antacids 30 ml 4.6 hourly can improve the condition.
Chronic gastritis :
Ans. When the acute gastritis remain for the longer time and is not treated, it becomes chronic and is known as chronic gastritis.
Etiology
1. Repeated injury to gastric mucosa by tea, coffee, alcohol, spices.
2. Infection from throat, teeth, gums and sinuses.
3. NSAIDS
4. Autoimmune pathology
5. Very hot beverage
6. Gastrectomy.
Types of Gastritis :
1. Superficial
2. Atrophic
3. Hypertrophic
4. Infectious
5. Eosinophilic
There are mainly two types of chronic gastritis:
A. Type A gastritis
B. Type B gastritis.
A. Type A Gastritis (Less common)
-It involves body of stomach and spars antrum.
-It is caused during autoimmune disorders like type I diabetes mellitus, Sjogrens syndrome, Graves disease, Hashimoto disease, myasthenia gravis, etc.
-It is caused due to autoimmune activity against parietal cells.
-Parietal cell antibodies can be detected in serum.
– In severe cases parietal cell atrophy leads to deficiency of intrinsic factor which leads to pernicious anemia.
-The disease is asymptomatic and long term complication is gastric carcinoma.
Treatment
-In severe cases corticosteroids are administered.
-In mild cases parenteral iron should be administered.
B. Type B Gastritis :
-This is more common form of gastritis and involves antrum of stomach.
-The usual cause is gram-negative bacteria H. pylori.
-The condition is precursor of peptic ulcer.
-There is possibility of gastric carcinoma.
Diagnosis
1. Gastric acid study, i.e. achlorhydria
2. Hemoglobin decreases
3. Serum gastrin increases
Management :
1. Anti-H. pylori Treatment
a. Triple drug therapy: Proton pump inhibitor or ranitidine 400 mg B.D. + Bismuth sub-citrate + Amoxicillin 1 gm or clarithromycin 500 mg or metronidazole 500 mg B.D.
b. Quadruple therapy: Omeprazole 10mg B.D.+ Tetracycline 500 mg QID+ Bismuth sub-citrate QID + Metronidazole 500 mg T.D.S.
In both the cases 14 days course is preferred.
2. Parenteral vitamin B, is administered.