“Gastric acid production is necessary for the body to digest food and break down nutritional components into absorbable amino acids, carbohydrates, and fats. Most of the acid is produced when gastric pH stimulates the release of gastrointestinal using the release and activation of various digestive enzymes. The stomach is a relatively acidic environment with a pH of less than 4.0, which can drop to 2.0 with parietal cells. Parietal cells live in the fundus and the body of the stomach and secrete hydrogen ions. This activity explains when this condition should be considered on a differential diagnosis, articulates how to properly evaluate for this condition, and highlights the role of the interprofessional team in caring for patients with this condition.”

• Early use of PPIs and H2 blockers in patients can be beneficial to prevent stress gastritis.
• PPIs work to inhibit hydrogen ion secretion by blocking the H/K ATPase of parietal cells.
• Parietal cells are stimulated by acetylcholine, gastrin, and histamine to secrete hydrogen ions.
• Acetylcholine and gastrin via phospholipase and PKC to stimulate hydrogen ion secretion.
• Histamine works through cAMP and PKA to stimulate hydrogen ion secretion.
• The most common presenting symptom is bleeding (bloody nasogastric tube, melena).

“Stress-induced gastritis is commonly encountered in clinical practice by the primary care provider, nurse practitioner, emergency department physician, pharmacist, and internist. The diagnosis is initially suspected based on the history and treated empirically with PPIs. If the symptoms resolve, the patient is urged to undertake stress-relieving measures, discontinue smoking, caffeinated beverages, alcohol, and NSAIDs.”

Megha R, Farooq U, Lopez PP. Stress-Induced Gastritis. [Updated 2023 Apr 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.