Category Archives: Internal Medicine

Chronic Superficial Gastritis: Common Symptoms and Clinical Manifestations

Chronic superficial gastritis is a prevalent gastric mucosal lesion characterized by inflammation confined to the superficial layer of the gastric wall. The condition is often triggered by Helicobacter pylori infection, prolonged use of non-steroidal anti-inflammatory drugs (NSAIDs), unhealthy dietary habits, or psychological stress. While some patients remain asymptomatic, many experience a range of upper gastrointestinal discomforts.

The most frequently reported symptoms include upper abdominal pain or discomfort, which may present as a dull ache or burning sensation. Patients often describe a feeling of fullness or distension after meals, even with small portions. Nausea, occasional vomiting, and acid reflux are also common. Some individuals may experience belching or early satiety, which can lead to reduced food intake and unintentional weight loss over time.

In certain cases, symptoms may worsen during fasting or at night, disrupting sleep and daily activities. Despite the chronic nature of the condition, the severity of symptoms can fluctuate, with periods of remission and exacerbation. It is important to note that the presence and intensity of symptoms do not always correlate with the extent of mucosal inflammation observed during endoscopy.

Symptom CategoryCommon Manifestations
Abdominal DiscomfortUpper abdominal pain, burning sensation, dull ache
Digestive IssuesPostprandial fullness, early satiety, belching, acid reflux
Nausea & VomitingMild to moderate nausea, occasional vomiting
Appetite ChangesLoss of appetite, feeling full quickly
Timing of SymptomsMay worsen when fasting or at night

Symptoms of Duodenal Ulcer

A duodenal ulcer typically presents with rhythmic, gnawing or burning epigastric pain that appears 2–3 h after meals or during the night and is promptly relieved by food, milk or antacids. Many patients also note early satiety, bloating, nausea and occasional retching; weight loss may occur because pain discourages eating. Pain can radiate to the back, and if an ulcer penetrates posteriorly it may cause continuous, non-relenting backache. Complications include sudden, severe, diffuse abdominal pain with board-like rigidity (perforation) or passage of black, tarry stools (bleeding). Alarm features—persistent vomiting, unexplained weight loss, anaemia, or recent onset of progressive symptoms—require urgent evaluation to exclude malignancy.

Symptom groupTypical featuresKey clues
Epigastric painBurning/gnawing, 2–3 h post-prandial or nocturnal, relieved by food/antacidRhythmic pattern
DyspepsiaEarly satiety, bloating, nauseaMeal-related
Weight lossReduced intake due to anticipated painPain-food cycle
Back painDeep, continuous if posterior penetrationNon-relenting
Alarm signsVomiting, melena, anaemia, progressive symptomsComplication/malignancy risk

What Are the Symptoms of Dysentery

Bacterial dysentery presents with rapid-onset colonic invasion, toxin damage and inflammatory exudate:

  1. Abdominal pain: mostly left-lower quadrant, colicky, worse before defecation, briefly relieved after
  2. Diarrhea: starts watery, quickly becomes mucopurulent and bloody; >10 stools/day, small volume
  3. Tenesmus: frequent urge, scanty difficult evacuation, strong anal bearing-down
  4. Fever: 38–40 °C with chills; toxic type may cause sudden convulsions
  5. Nausea/vomiting: more common in children; bilious in severe cases
  6. Mucopurulent bloody stool: dark or bright red, sticky, fishy odor
  7. Toxic type (ages 2–7): high fever, convulsions, altered consciousness or shock before diarrhea appears

Seek care promptly if diarrhea >1 day with blood, tenesmus or high fever to prevent dehydration and toxic complications.

Symptom groupTypical featuresFrequency
Abdominal painLeft-lower colicky, post-defecation reliefUniversal
DiarrheaWatery→bloody mucus, >10/dayUniversal
TenesmusUrgent, scanty, strainingUniversal
Fever38–40 °C, chillsCommon
Nausea/vomitingGastric content, kids>adultsCommon
Toxic typeHigh fever, convulsions, shockRare but critical

What Are the Symptoms of Cholecystitis

Cholecystitis is acute or chronic inflammation of the gallbladder wall; 95 % of cases follow stone obstruction of the cystic duct. Core symptoms escalate over time:

  1. Colicky or persistent dull right-upper-quadrant pain, often sudden after a fatty meal, radiating to the right scapula or back
  2. Nausea and repeated vomiting that does not relieve the pain
  3. Fever ≥38 °C with chills, marking advancing inflammation
  4. Classic Murphy sign: inspiratory arrest when the examiner presses below the right costal margin
  5. Pain persisting >6 h suggests acute cholecystitis
  6. In severe cases jaundice, tachycardia or hypotension signals risk of suppuration or perforation
  7. Chronic cholecystitis presents as intermittent bloating, eructation and fatty-food intolerance, often mistaken for “gastritis”

Seek immediate care if right-upper pain >6 h is accompanied by fever or jaundice; early surgery (within 72 h) markedly reduces complications.

Symptom groupTypical featuresTime/sign clues
RUQ painColic→dull ache, refers to shoulder/backSudden after fat meal, >6 h unrelieved
GINausea, repeated vomiting, no pain reliefAppears almost with biliary colic
Fever≥38 °C with chillsMarker of advancing inflammation
Murphy signInspiratory arrest on RUQ palpationClassic physical finding
JaundiceYellow skin/scleraImpacted stone or CBD compression
SystemicTachycardia, hypotensionWarn of pus, gangrene or perforation

What Are the Symptoms of Bile Reflux Gastritis

Bile reflux gastritis is chronic inflammation caused by duodenal contents (bile, pancreatic juice) flowing back into the stomach. Core symptoms result from bile irritation and breakdown of the gastric mucosal barrier:

  1. Burning or persistent dull upper-abdominal pain, worse after meals and poorly relieved by antacids
  2. Frequent belching with bitter or sour taste; bitter mouth noticeable on waking or when fasting
  3. Nausea and occasional bilious vomiting—yellow-green fluid without blood
  4. Early satiety and post-prandial fullness: reduced gastric accommodation, feeling full after small meals
  5. Loss of appetite and weight: decreased intake due to prolonged discomfort
  6. Epigastric heat: located higher than typical heartburn, aggravated at night or when lying flat
  7. Emotional link: anxiety or stress may trigger or worsen symptoms

Symptoms overlap with acid reflux but respond poorly to acid suppression; morning bitterness and bilious vomiting are fairly specific clues. Chronic reflux can produce erosions and metaplasia; diagnosis requires gastroscopy.

Symptom groupTypical descriptionDifference from acid reflux
Upper pain/burnPersistent dull or burning, worse post-prandialPoor response to antacids
Bitter mouth/bile vomitStrong bitter taste, yellow-green vomitusRare in acid reflux
Early fullnessFull after small meals, frequent belchingSimilar but more stubborn
Appetite/weightGradual decreaseCorrelates with discomfort
Night/supineHeat and bitterness increaseSimilar

Symptoms and Manifestations of Fatty Liver

Most patients with metabolic-dysfunction-associated steatotic liver disease (MASLD, formerly NAFLD) are asymptomatic in early stages; findings are often incidental on health check-ups. Key features relate to metabolic disturbance and hepatic fat accumulation:

  • Splenomegaly, thrombocytopenia: congestive hypersplenism
  • Fatigue: commonest, linked to hepatocyte energy impairment
  • Right upper-quadrant dull pain or discomfort: from stretched Glisson capsule
  • Loss of appetite/early satiety: reduced gastric accommodation with post-prandial fullness
  • Weight gain or central obesity: background of metabolic syndrome
  • Skin pruritus: retained bile acids irritating peripheral nerves
  • Spider naevi, palmar erythema: decreased oestrogen clearance → peripheral vasodilatation
  • Ascites, leg oedema: combined hypoalbuminaemia and portal hypertension (advanced stage)
  • Jaundice: impaired bilirubin uptake/conjugation/excretion (significant fibrosis/cirrhosis)
  • Poor concentration, somnolence: rising blood ammonia, subtle hepatic encephalopathy
Symptom groupTypical descriptionStage seen
Metabolic fatigueEasy tiring, reduced exercise toleranceEarly
RUQ discomfortVague ache/fullness worse after mealsEarly-mid
DyspepsiaEarly satiety, belching, nauseaEarly
Skin signsItch, spider naevi, palmar erythemaMid
Fluid retentionAnkle oedema, ascitesMid-advanced
Bleeding tendencyEpistaxis, gum bleedingAdvanced
Neuro-psychiatricPoor focus, sleepinessAdvanced

Symptoms of Alcoholic Liver Disease

Patients often present with features linked to impaired hepatic metabolism and inflammation:

  • Oliguria, rising creatinine: hepatorenal syndrome
  • Fatigue: earliest and most common, easily overlooked
  • Anorexia, nausea, vomiting: lead to weight loss
  • Dull or dragging right upper quadrant pain: enlarged liver stretches Glisson capsule
  • Jaundice: yellow skin/sclera indicate cholestasis
  • Low-grade fever: cytokine-driven
  • Ascites, leg edema: portal hypertension plus hypoalbuminaemia
  • Spider naevi, palmar erythema: failed oestrogen clearance
  • Confusion, somnolence: early hepatic encephalopathy
  • Haematemesis, melaena: ruptured oesophageal/gastric varices
Symptom groupTypical picturePathogenesis
FatigueEarly, persistentImpaired hepatocyte energy metabolism
GIAnorexia, nausea, RUQ acheCapsular stretch from hepatomegaly
JaundiceYellow skin/scleraReduced bilirubin uptake/conjugation
BleedingSpider naevi, epistaxis, melaenaDecreased clotting-factor synthesis
Ascites/oedemaDistended abdomen, pitting ankle oedemaPortal hypertension + hypoalbuminaemia
Neuro-psychiatricDrowsiness, disorientationElevated ammonia & toxins
RenalOliguria, rising ureaHepatorenal syndrome

Symptoms of Gastroptosis

Patients often experience recurrent upper-abdominal discomfort related to the low position of the stomach, delayed emptying and secondary reflux:

  1. Epigastric pain or dull ache, usually within 1 h after meals, worsened by standing or activity and eased by bending forward or hugging the knees
  2. Marked fullness: feeling distended after only a small meal, accompanied by frequent belching
  3. Dyspepsia: acid regurgitation, nausea, occasional retching with gastric (non-bilious) content
  4. Delayed gastric emptying leads to loss of appetite and, in the long term, weight loss and fatigue
  5. Some cases report retro-sternal or back radiation, linked to reflux gastritis
  6. Symptoms are aggravated by prolonged standing, fatigue, post-prandial exertion or emotional stress, and are usually relieved by lying flat or at night

Persistent or recurrent complaints should prompt upright barium meal or gastroscopy for confirmation.

Symptom groupTypical descriptionPrecipitating/relieving factors
Epigastric painPost-prandial dull or distending ache, may radiate to backStanding↑ Bending↓
FullnessFeeling filled after small intakePost-meal↑ Supine↓
Belching/acidFrequent sour eructationsActivity↑ Knee-hug↓
Nausea/appetite↓Occasional retching, reduced food intakeStress↑ Rest↓
Weight lossResult of chronic inadequate intakeFatigue↑ Small-frequent meals↑

What Causes Colitis

Inflammation of the colonic mucosa can be triggered by infection, immune dysregulation, impaired blood supply, drugs or radiation.

Diet and lifestyle: High intakes of red meat, emulsifiers and sweets, together with smoking and obesity, are considered modern “Western-style” pro-inflammatory factors.

Infection: Salmonella, Shigella, Clostridioides difficile, Mycobacterium tuberculosis and Entamoeba histolytica directly invade the epithelium, causing acute diarrhoea and bloody stools.

Immune factors: Ulcerative colitis and Crohn’s disease are autoimmune disorders in which genetically susceptible individuals mount an abnormal T-cell response that continuously attacks the bowel wall.

Microbial dysbiosis: Long-term antibiotics and a high-fat, low-fibre diet reduce protective flora and increase pro-inflammatory bacteria, driving chronic inflammation.

Ischaemia: Hypotension, arteriosclerosis or thrombosis can lead to ischaemic colitis with sudden left-lower-quadrant pain and bloody diarrhoea.

Drugs and radiation: NSAIDs, aspirin, chemotherapeutic agents and pelvic radiotherapy directly injure the epithelium or induce local vasculitis.

CategoryMain mechanismCommon triggersClinical clues
InfectiousPathogen invasionContaminated water/food, C.diff after antibioticsAcute fever, bloody pus stool
ImmuneAuto-immune attackGenetic susceptibility + environmental triggersChronic relapses, mucus-blood stool
IschaemicInadequate blood flowArteriosclerosis, thrombosis, shockSudden pain + bloody diarrhoea
Drug/RadiationDirect toxicity or vascular injuryNSAIDs, chemotherapy, pelvic radiotherapyDiarrhoea after drug/RT course
DysbiosisProtective ↓ pro-inflammatory ↑High-fat low-fibre diet, long-term antibioticsBloating, watery diarrhoea, recurrent

What Causes Reflux Esophagitis

The core issue is retrograde flow of gastric contents (acid, pepsin, bile) into the esophagus, leading to mucosal erosion. Key mechanisms include:

  • Reduced lower-esophageal-sphincter (LES) pressure or frequent transient LES relaxations (TLESRs) that disable the anti-reflux barrier
  • Hiatus hernia, which weakens the diaphragmatic crus and creates an acid pocket
  • Impaired esophageal clearance (weak peristalsis, reduced saliva) that prolongs acid exposure
  • A damaged mucosal barrier (widened intercellular spaces, thinner mucus layer) lowering resistance to aggressive factors

Obesity, pregnancy, late-night meals, high-fat diet, smoking, alcohol and drugs such as aspirin raise intra-abdominal pressure or directly relax the sphincter, aggravating reflux. Chronic reflux activates inflammatory mediators, inducing erosions and ulcers that may progress to circumferential disease or columnar metaplasia (Barrett esophagus).

Key stepMain changePrecipitating factors
Anti-reflux barrier ↓Low LES pressure, TLESRs, hiatus herniaHigh-fat meals, smoking, alcohol, obesity
Clearance function ↓Weak peristalsis, low saliva, long acid dwellDehydration, supine position, ageing
Mucosal barrier ↓Widened intercellular spaces, less mucusBile acids, NSAIDs, prolonged acid
Aggressive factors ↑Acid, pepsin, bile refluxLarge meals, coffee, aspirin