Lifestyle changes may help with gastritis

Q: Can you please talk about gastritis - what it is and why someone gets it? I think I have it, but I don't understand how it happened. Also, is there a special diet you should be on when you're recovering from it? What about probiotics?

A: Gastritis is a condition that occurs when something causes the inner layer of specialized cells that line the stomach to become irritated, swollen or inflamed. This portion of the stomach lining, which is known as the mucosa, is home to glands that secrete the enzymes and acids that aid in digestion.

The mucosa also has several defense mechanisms that protect it from the corrosive effects of the digestive juices that it releases, and from infectious agents, such as bacteria and viruses. But if those defenses become weakened or begin to fail, damage to the stomach lining can occur.

The most common cause of gastritis is infection with the bacterium H. pylori. Because the mucosa often grows thinner as we age, older adults can be at increased risk of developing the condition.

It can also arise due to the overuse of nonsteroidal anti-inflammatory drugs, excessive alcohol use, autoimmune disorders, excessive stomach acid production related to stress, chronic vomiting and as a side effect of some medications and medical treatments.

The chronic inflammation of gastritis, when left untreated, can lead to developing stomach ulcers. This can result in serious complications, such as perforation and bleeding in the stomach lining, or it may progress toward gastric cancer.

When someone has gastritis, they may feel a burning, aching or gnawing feeling in the upper abdomen. Additional symptoms can include a feeling of fullness, nausea, vomiting, loss of appetite, persistent belching or hiccups, and blood in the stool. However, it is also possible to have gastritis but not experience noticeable symptoms.

Diagnosis often begins with breath or stool tests for the presence of H. pylori. It can also include the use of a scope to examine the stomach or imaging tests of the digestive organs. Treatment may include antibiotics to address H. pylori infection and a range of medications to lessen or block the production of stomach acid.

You're on the right track in asking about diet. The foods you eat - and also those that you avoid - can be helpful in managing symptoms of the condition. Contrary to popular belief, spicy and greasy foods don't cause gastritis. However, they can certainly aggravate symptoms, so it is wise to steer clear of them.

The same goes for highly processed foods, carbonated beverages, acidic foods and those high in added sugars. Choose a diet of lean proteins and include high-fiber foods such as whole grains, legumes, fresh fruit, vegetables and leafy greens. Cut out, or at least strictly limit, alcohol consumption. Avoid eating a few hours before bed.

As for probiotics, recent studies suggest that, in cases of gastritis arising from bacterial infection, they can be helpful. Check with your doctor about whether you might benefit from probiotic supplements.

Q: I'd like information about meniscus tears. I am a 59-year-old active woman, and I just tore my meniscus in two places. I also have osteoarthritis. I'm told that surgery is no longer recommended. Is this correct? What can be done?

A: To talk about the meniscus, we should start with the knee joint. It connects the femur, or thigh bone, to the tibia, which is the shin bone. Thick bands of fibrous connective tissue, known as ligaments, join the two bones. The bones themselves are tipped with cartilage, a smooth and springy connective tissue that reduces friction in areas where bone meets bone and serves as a shock absorber.

And that's where the meniscus comes into play. It's a wedge-shaped arc of cartilage tucked between the femur and tibia.

Each knee joint actually has two - the plural is menisci. The one on the inner side of the knee is known as the medial meniscus, and the one on the outer side is the lateral meniscus. They help support the knee and provide additional stability and cushioning.

Twisting or rotating the knee with enough force, particularly when the foot remains planted in place, can injure the meniscus. So can direct impact to the knee or strain caused by rising from a sitting or squatting position. The tissues of the meniscus can gradually wear down over time, and they can become weakened by the inflammatory effects of autoimmune conditions, such as osteoarthritis.

Damage to the meniscus can range from minor, such as a strain, sprain or small tear, to quite severe. This includes horizontal splits, longitudinal tears or even complete detachment. Most injuries to the meniscus will cause knee pain, stiffness and swelling. There is often a sensation of something catching inside of the knee. When the damage is severe, movement becomes difficult or impossible. Popping sounds within the knee are often audible.

Diagnosis is via a physical exam. Imaging tests may be used to visually assess the soft tissues of the knee and to exclude other possible causes for the symptoms. Treatment varies depending on the person's age, activity level and the location and severity of the injury.

A small tear located in the outer portion of the meniscus, which has a robust blood supply, can often heal on its own. But when damage extends to the inner two-thirds of the meniscus, which lacks a significant blood supply, surgical repair can become necessary.

In our practices, we base treatment decisions for a torn meniscus on each patient's individual needs. This includes an assessment of any coexisting health conditions. A patient with a severe tear can have mild pain and choose not to have surgery, while someone with a mild tear but in great pain may need surgical intervention. A young athlete will likely opt for surgical repair, whereas an 80-year-old with poor health status may decline.

Meniscal tears can increase the risk of developing knee arthritis, and perhaps the eventual need for a knee replacement. In our practices, when it comes to meniscus injuries, we treat the patient, not the test results.

• Dr. Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr. Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu.