Dr Shirurkar Manali Ramchandra
ABSTRACT
Erosive gastritis is gastric mucosal erosion caused by damage to mucosal defences. It is typically acute, manifesting with bleeding but can be subacute or chronic with few or no symptoms. symptoms may include a burning and heavy feeling in the pit of the stomach, mild nausea, vomiting, loss of appetite and weakness. In severe cases there can be bleeding of the stomach which may result in anemia. A 42-year-old female presented with distension of abdomen, heartburn, eructation’s empty and easy satiety since 2 years. A detailed case taking was done and after repertorization and referring to materia medica Lachesis was prescribed.
Key words- erosive gastritis, Lachesis, homeopathy, gastrointestinal disorders.
INTRODUCTION
Erosive gastritis is gastric mucosal erosion caused by damage to mucosal defences. It is typically acute, manifesting with bleeding but can be subacute or chronic with few or no symptoms1. An estimated 50% of the world population is infected with H pylori; consequently, chronic gastritis is extremely frequent. H pylori infection is highly prevalent in Asia and in developing countries, and multifocal atrophic gastritis and gastric adenocarcinomas are more prevalent in these areas2.
Erosive gastritis is classified in ICD-10 diagnostic manual under the code 2023 ICD-10-CM Diagnosis Code K29.603. Modern aspects of gastritis classification and knowledge of its biological course and consequences were relatively well-known at the time when Helicobacter pylori (H. pylori) was discovered by Robin Warren and Barry Marshall in 1982 (Warren & Marshall, 1983). Their discovery showed that the commonest form of gastritis is simply an infectious disease caused by an otherwise known pathogen. At that time gastroenterologist and pathologist had limited knowledge on even simple aspects of this chronic bacterial inflammation of gastric mucosa but considerable amount of data became known about H. pylori, its disease associations and their natural course. Presently Type, severity and extent of gastric inflammation linked to possible etiology can be well detailed4.
Common causes of erosive gastritis include Nonsteroidal anti-inflammatory drugs (NSAIDs), Alcohol, Stress. Less common causes of erosive gastritis include Radiation, Viral infection (eg, cytomegalovirus), Vascular injury, Direct trauma (eg,nasogastric tubes),Crohn’s disease. Superficial erosions and punctate mucosal lesions occur. These may develop as soon as 12 hours after the initial insult. Deep erosions, ulcers, and sometimes perforation may occur in severe or untreated cases. Lesions typically occur in the body, but the antrum may also be involved1.
Chronic, Erosive Gastritis is an inflammation of the stomach characterized by multiple lesions in the mucous lining causing ulcer-like symptoms. These symptoms may include a burning and heavy feeling in the pit of the stomach, mild nausea, vomiting, loss of appetite and weakness. In severe cases there can be bleeding of the stomach which may result in anemia. Some people with this disorder, especially chronic aspirin users, may show no apparent symptoms until the disease has advanced5.
CASE REPORT
- Name- Mrs S
- Age – 42 yrs
- Sex- Female
- Occupation- housewife
- Marital status- married
- Religion- hindu
- Address- basaveshwarnagar
- Date – 11/10/2022
Presenting Complaint
C/O distension of abdomen, heartburn, eructation’s empty and easy satiety since 2 years
History of Presenting Complaint
Patient was apparently well 2 years ago. Then she started with easy satiety, occasionally no appetie. Due to loss of appetite when she would be on empty stomach, she would have empty eructations and heartburn. Then patient also started with pricking type of pain in epigastric region after this she consulted a doctor and was suggested for an endoscopy. She took allopathic medicines for 3 months and felt better. Then again, she started with the same complaints. Presently patient complains of easy satiety, distension of abdomen, eructations on empty stomach, heartburn more on empty stomach.
| LOCATION | SENSATION | AILMENTS FROM/ MODALITY | CONCOMITANT | |
| 1) GIT
Abdomen Since 2 years Gradual onset and progression chest |
Distension Eructation easy satiety burning |
<empty stomach
|
weakness
|
Past History
- Surgical history – D&C two times for abortion at 3rd month
- No allergic history
Family History
- Father and mother – alive and apparently healthy
Personal History
- Diet- Mixed
- Appetite- loss of appetite
- Hunger – reduced
- Thirst – Thirstless
- Desire- nil
- Aversion – to food
- Urine- 3-4 times / day, no burning & itching,
- Bowel movement – once in 4 days, hard stools, straining to pass
- Perspiration – generalized
- Sleep –good.
- Dreams – N.S
- Thermals – chilly patient
Menstrual history
- LMP 9/10/22
- Regular 28 days cycle
- Normal dark red bleeding, clots are present.
- Pads used per day 2
- Abdominal pain during menses
Obstetric history
- G4 P2 L2 A2
- Full term NVHD
- 1st child 24 years male
- 2nd child male 20 years
Life Space Investigations
Patient hails from middle socioeconomic family. She has 2 sons. They are all very harmonious. 2 years back patient was very worried about her husband as he had taken loan and now, she has to give the loan. Moneylenders kept asking for money. Patient is not working. She is very worried about it. Children are like they can’t give the loan money. So now she stopped eating all the time. She is worrying about money hence she is in trouble; she feels like her husband is root cause of all her problems. She is like if she doesn’t worry then her husband will commit suicide.
On observation patient wept while narrating complaints. Complaining about family. Anxiety about health. Anger when someone lies to her.
General Physical Examination & Vitals
- Conscious & oriented with time, place and person.
- No edema, clubbing, cyanosis, icterus
- Pallor present
- BP- 110/70mm Hg
- PR – 76 beats/ min
- Temp – afebrile at the time of examination
Systemic Examination
- Respiratory system
- B/L normal vesicular breathing sounds- heard
- No added sounds
- Cardiac system – S1 & S2 heard, no murmur heard.
- Gastrointestinal system
Inspection: no scar, no lump, no visible pulsation
Palpation: no tenderness
Percussion: tympanic note heard
Auscultation: 3 to 5 bowel sounds heard per minute
Laboratory Investigation & Findings
Endoscopy done on February 2021
-erosion in antrum
-chronic erosive gastritis
Blood investigation as on 10/10/2022
- FBS 69mg/dl
- PPBS 98mg/dl
- Serum creatinine-1.0mg/dl
Provisional Diagnosis : Chronic erosive gastritis
Classification Of Disease: Chronic Miasmatic Pseudo-Psora
School of Philosophy – Kent School Of Philosophy
Analysis of Case
| Common Symptoms | Uncommon symptoms |
|
|
Evaluation of Symptoms
| Mental generals | Physical generals | Characteristic particulars |
|
|
|
Totality of Symptom
- deceitful – changes her statements frequently
- weeping all the time while narrating her complaints.
- Anxiety about health
- Anger when someone lies to her.
- thirstless
- loss of appetite
- chilly patient
- distension of abdomen
- eructation
- loss of appetite
- heartburn
Repertorial Approach – Synthesis Repertory
Repertorial Totality6
- Mind- deceitful,cunning
- Mind – anxiety, health about
- Hunger& thirst- loss of appetite
- Abdomen- distension
- Stomach- eructation empty
Repertorization proper
- Sulph 11/4
- Lach 10/5
- Ars 10/4
- Calc 10/4
- Cocc 10/4
- Phos 10/4
Prescription
- lach 200 – 1 dose
- NP 6x 2-2-2
- Rubrum TID-
BASIS OF PRESCRIPTION
Based on analysis of mental generals,physical generals, particulars and reportorial result Lachesis was prescribed. Even though both arsenicum and Lachesis have anxiety about health, due to lack of restlessness due to anxiety arsenicum was ruled out. Patient would change her sentences and seemed to be deceitful hence Lachesis was chosen. 200C potency was chosen based on the susceptibility and nature of the disease. Infrequent repetition was chosen based on seat of the disease and its intensity.
Follow up
| DATE | SYMPTOMS | PRESCRIPTION |
|
12/10/22 |
c/o easy satiety- better
Appetite increased c/o weakness no new complaints no other altered generals |
Rubrum TID- 15 days |
|
5/11/22 |
c/o distension of abdomen- better
Appetite- good No easy satiety No new complaints Patient was suggested to take an endoscopy scan but the patient refused as the procedure was painful. |
Rubrum TID- 15 days
|
|
10/11/22 |
c/o distension of abdomen- better
Appetite- good No new complaints |
lach 200 – 1 dose Rubrum TID- 15 days |
CONCLUSION
Homoeopathy is a holistic approach which treats the person as a whole. Most of the gastric complaints stem from affections on mental plane. In this case striking mental features were elicited and used to prescribe. Complete symptomatic relief can be seen within 2 months of prescription. Pathological changes could not be seen due to unwillingness of patient to get an endoscopy done. Homeopathy can stop the further advancement in the condition and give relief to the patient.
Conflict Of Interest– Nil
Funding– Nil
Consent For Publication– written informed consent was obtained from the patient for publication of this case report.
BIBLIOGRAPHY
- Porter, R. S., & Kaplan, J. L. (Eds.). (2011). The Merck manual of diagnosis and therapy (19th ed.).
- Pounder RE, Ng D. The prevalence of Helicobacter pylori infection in different countries. Aliment Pharmacol Ther. 1995. 9 Suppl 2:33-9.
- World Health Organization. (2004). ICD-10 : international statistical classification of diseases and related health problems : tenth revision, 2nd ed. World Health Organization.
- Szabo IL, Czimmer J, Mozsik G. Diagnosis of Gastritis–Review from Early Pathological Evaluation to Present Day Management. Current Topics in Gastritis. 2012;19.
- Putkowski S. The National Organization for Rare Disorders (NORD) providing advocacy for people with rare disorders. NASN school nurse. 2010 Jan;25(1):38-41.
- Synthesis repertory
Dr Shirurkar Manali Ramchandra
PG Scholar,Department Of Practice Of Medicine
Government Homoeopathic College & Hospital Bangalore- 560079
shirurkarmanali@gmail.com
Under The Guidance Of
Dr Praveen Kumar PD
HOD & Professor
Department Of Practice Of Medicine
Government Homoeopathic College & Hospital Bangalore- 560079
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