Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Gastritis


Related Terms

  • Acute Gastritis
  • Atrophic Gastritis
  • Chronic Gastritis
  • Dyspepsia
  • Erosive Gastritis
  • Gastric Inflammation
  • Stomach Inflammation

Differential Diagnosis

Specialists

  • Gastroenterologist
  • Internal Medicine Physician

Comorbid Conditions

Factors Influencing Duration

Factors that may influence the length of disability include the underlying cause of the gastritis, degree of inflammation, treatment prescribed, and development of complications.

Medical Codes

ICD-9-CM:
535.00 - Gastritis, Acute, without Mention of Hemorrhage
535.01 - Gastritis, Acute, with Hemorrhage
535.10 - Atrophic Gastritis, without Mention of Hemorrhage
535.11 - Atrophic Gastritis, with Hemorrhage
535.20 - Gastric Mucosal Hypertrophy, without Mention of Hemorrhage
535.21 - Gastric Mucosal Hypertrophy, with Hemorrhage
535.30 - Alcoholic Gastritis, without Mention of Hemorrhage
535.31 - Alcoholic Gastritis, with Hemorrhage
535.40 - Gastritis, Other Specified, without Mention of Hemorrhage
535.41 - Gastritis, Other Specified, with Hemorrhage
535.50 - Gastritis and Gastroduodenitis, Unspecified, without Mention of Hemorrhage
535.51 - Gastritis and Gastroduodenitis, Unspecified, with Hemorrhage

Overview

Gastritis is a common ailment involving inflammation of the stomach lining that causes general discomfort and, rarely, gastrointestinal bleeding.

There are two forms of gastritis, acute and chronic. Acute gastritis is mild and temporary, lasting up to 2 days, and can result from any number of causes. Acute gastritis may be caused by stomach acid-induced damage; by excessive smoking or alcohol consumption; or as a side effect of aspirin, certain prescription medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), or foods contaminated with certain bacteria. Accidental or purposeful ingestion of ammonia, lye, or cleaning agents (corrosive alkali) or acids can lead to erosive acute gastritis. Conditions that produce severe stress such as shock, trauma, or major surgery may also cause gastritis. Finally, acute gastritis may be caused by certain medical procedures (iatrogenic) including radiation therapy and administration of anticancer drugs (chemotherapeutic agents).

Chronic gastritis is a progressive, irreversible decay (atrophy) of the lining (gastric mucosa) and glandular tissue within the stomach. This leaves a less effective barrier to the corrosive and digestive properties of hydrochloric acid and pepsin contained within the stomach. There are two forms of chronic gastritis. Type A gastritis (also known as autoimmune atrophic gastritis) may be triggered by a physical or psycho-emotional stressor that causes the individual's immune system to produce antibodies against certain cells in the stomach (parietal cells). Destruction of these cells results in atrophy of the stomach tissue. Type B gastritis (or simple atrophic gastritis) is more common and is strongly associated with the presence of a certain bacterium (Helicobacter pylori or H. pylori) in the stomach mucosa. Helicobacter pylori infection is the most frequent cause of chronic gastritis. The presence of H. pylori may also lead to eosinophilic gastritis, although this can also be caused by food allergies, usually milk or soy protein. Other causes of simple atrophic gastritis may include chronic alcohol or cigarette use, exposure to toxins such as lead, and certain metabolic conditions that may occur during renal failure (uremia).

Incidence and Prevalence: In the US, the overall prevalence of chronic gastritis is about 35% and has been decreasing steadily since 1950 (Mukherjee).

Source: Medical Disability Advisor



Causation and Known Risk Factors

The frequency of gastritis increases with age. Gastritis caused by H. pylori is more common in older individuals born before 1950 (Mukherjee); it is estimated that 20% of individuals younger than 40 years of age and 50% to 60% of individuals older than 60 are infected with H. pylori (Sepulveda, Shayne). Infection with H. pylori is most common in black American, Hispanic, Asian-American, and Native American individuals (Mukherjee, Sepulveda).

Men and women are equally affected by most forms of gastritis, although autoimmune gastritis is 3 times more common in women than in men (Mukherjee).

Individuals also at risk for acute gastritis are those who use aspirin or other NSAIDs, steroids, potassium, or iron supplements; drink excessive alcohol; eat contaminated raw fish; or have a history of peptic ulcer disease. Acute stress gastritis is present in up to 5% of individuals who are admitted for ICU hospitalization (Cohen).

Source: Medical Disability Advisor



Diagnosis

History: Individuals with acute gastritis may report lack of appetite (anorexia), burning or gnawing upper abdominal discomfort or pain that may radiate to the back, bloating, belching, diarrhea, blood in the stool or sputum, or nausea and vomiting. Individuals with chronic gastritis may report vague stomach distress, a sensation of fullness, nausea, malaise, a heavy feeling in the stomach after meals, or ulcer-like symptoms. Symptoms typically occur within 1 to 5 hours after meals (Shayne). With severe gastritis, the individual may also report chest pain, sweating, and feeling faint.

There may be a history of ulcers, recent use of NSAIDs such as aspirin or ibuprofen, recent ingestion of highly acidic food or chemicals, recent radiation or surgical procedure, or past gastrointestinal illness. The individual may report having eaten raw fish. The individual's history should include information regarding eating, drinking, and smoking habits as well as prescription and nonprescription drug use.

Physical exam: The exam results are most often normal. Rarely, there is abdominal tenderness, pale skin, rapid heartbeat (tachycardia), shortness of breath (dyspnea), or low blood pressure (hypotension). The individual may have foul-smelling breath (halitosis).

Tests: Gastritis is typically diagnosed by the history and physical examination. Tests that may be done include various blood tests (hematocrit and hemoglobin indices) for low hemoglobin in the bloodstream (anemia), and blood tests for markers of H. pylori infection. H. pylori infections can also be diagnosed by a breath test (urea breath test), a stool antigen test, and histological evaluations of biopsy samples. The presence of antibodies in the blood does not necessarily indicate active infection. The inner lining of the stomach may be visualized using a flexible fiberoptic microscope (endoscope); during this procedure a tissue sample of the stomach mucosa may also be taken for analysis (endoscopic biopsy). The stomach can also be visualized after swallowing a radiopaque contrast medium (barium) and taking x-rays (barium swallow). A tube can be inserted through the nose and into the stomach (nasogastric tube) to obtain samples of stomach secretions (gastric analysis). A stool sample may be taken to check for the presence of blood and to detect H. pylori in the digestive tract. Individuals reporting chest pain may require an electrocardiogram to rule out heart attack (myocardial infarction).

Source: Medical Disability Advisor



Treatment

Treatment is primarily supportive, and antacids in either liquid or tablet form may be sufficient to treat cases of mild gastritis. Antacids may also be used if the gastritis is associated with an ulcer. Gastritis caused by NSAIDs usage may be treated by taking the drug with food, decreasing the dose, or discontinuing the drug. Excess stomach acid production may be treated with drugs such as a histamine receptor antagonist or a proton pump inhibitor. Medications that coat and protect the stomach lining may also be used. Gastritis due to alcohol consumption is usually mild and treated by counseling the individual to either stop or decrease the amount of alcohol consumed. Individuals with symptoms aggravated by caffeine consumption are instructed to limit coffee, tea, and caffeinated beverages (Burg). Should the individual be deficient in vitamin B12, shots must be received on a monthly basis. A blood transfusion may be required if severe bleeding has occurred. Endoscopic surgery to stop the bleeding (hemostasis) or surgery to remove part of the stomach (subtotal gastrectomy) is indicated in rare instances. Chronic gastritis caused by H. pylori is very effectively treated with triple drug combination therapy using two antibiotics with a proton pump inhibitor, usually given for 10 to 14 days to eradicate the infection (Mukherjee).

Source: Medical Disability Advisor



Prognosis

The predicted outcome associated with acute gastritis is related to the cause of the gastritis. Most individuals with acute gastritis recover completely within 48 hours of starting treatment. Acute gastritis due to stress or associated with bleeding has a poorer prognosis, and longer recovery times may be expected. Type A gastritis (autoimmune atrophic gastritis) can result in destruction of a compound secreted by the stomach (intrinsic factor) that allows vitamin B12 to be absorbed. A form of anemia (pernicious anemia) may result if the individual becomes deficient in vitamin B12. Injections of vitamin B12 can alleviate this condition.

Chronic gastritis associated with H. pylori infection (type B gastritis, or simple atrophic gastritis) is normally managed successfully with drug therapy; resolution of H. pylori infection is typically achieved in 80% to 95% of cases (Sepulveda). It may occasionally progress to ulceration, necessitating a longer course of treatment. If a stomach ulcer is present, subtotal gastrectomy may be used as a treatment. Simple atrophic gastritis may progress to chronic atrophic gastritis, which is associated with the development of stomach cancer.

Source: Medical Disability Advisor



Rehabilitation

Regular physical activity on a daily basis is recommended to relieve stress that may exacerbate gastritis. Aerobic exercise such as walking, jogging, or swimming is usually beneficial.

In the rare instance in which a portion of the stomach is removed surgically (subtotal gastrectomy), intermittent positive pressure breathing exercises may be necessary to prevent pulmonary complications.

Certain exercises may also be performed to reduce postoperative pain and speed recovery, such as progressive relaxation and deep-breathing techniques until pain from inhalation/exhalation is less noticeable. Range of motion and isometric exercises of the lower extremities will help to increase circulation and make walking easier, especially when performed during the first 48 hours after surgery. Individuals may continue with these exercises until recovery from surgery is complete and pain is no longer noticeable while walking or breathing.

Source: Medical Disability Advisor



Complications

Complications associated with acute gastritis can include formation of lesions in the mucosal lining of the stomach (ulceration) and bleeding (hemorrhage) from the wall of the stomach. Chronic gastritis is often without symptoms for a period of time until atrophy of the stomach becomes severe enough that it interferes with digestion and emptying of food into the small intestine. Resulting complications may include fatigue and vague discomfort after eating. With chronic gastritis from H. pylori infection, up to 17% of individuals develop peptic ulcers, 25% are unable to secrete adequate amounts of stomach acid for digestion, and 1% to 3% may develop stomach cancer (Mukherjee).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

No work restrictions or accommodations are usually required following the recovery period. If the individual is treated with a subtotal gastrectomy, recovery may be expected in 4 to 6 weeks. During this time, heavy lifting should be restricted, and a more sedentary job may be necessary.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Did individual present with symptoms of anorexia, upper abdominal discomfort or pain, vomiting, or diarrhea?
  • Was the possibility of food poisoning ruled out?
  • Does individual have a history of chronic alcohol, caffeine, or NSAIDs use?
  • Has a diagnosis of gastritis been determined by history and physical exam?
  • If diagnosis was uncertain, were other diagnostic studies done (i.e., gastrointestinal x-rays or endoscopy) to rule out other conditions such as gastric ulcer, perforation of the stomach, gastric cancer, and gastroesophageal reflux?
  • Was an electrocardiogram necessary to rule out myocardial infarction?

Regarding treatment:

  • If elimination of gastric irritants and administration of antacids were not effective, what treatment options are now being considered?
  • Is drug treatment with histamine receptor antagonist or proton pump inhibitor necessary? Has individual been following drug therapy regimen as prescribed?
  • Has individual been tested for the presence of H. pylori? If so, is infection eradication being addressed in the treatment plan?
  • Have blood tests been done to rule out the possibility of associated pernicious anemia? Has individual received vitamin B12 injections as needed to treat pernicious anemia?
  • Was condition severe enough that emergency treatment and / or hospitalization was necessary? Was surgery necessary? If so, what procedure?

Regarding prognosis:

  • Based on underlying cause of the gastritis, has adequate time elapsed for recovery (48 to 72 hours)?
  • Has individual been successful in limiting alcohol intake? Would individual benefit from counseling or enrollment in a community program?
  • Has individual been compliant with monthly injections of vitamin B12? If not, what can be done to increase compliance?
  • Is individual receiving appropriate antibiotic therapy to eradicate H. pylori infection?
  • If symptoms have persisted, is surgery indicated?
  • Has individual experienced any complications (such as ulceration, chronic gastritis, or hemorrhage) that could affect recovery and prognosis?
  • Is there an underlying condition (bleeding disorders, cancer, peptic ulcer disease) that could affect recovery?

Source: Medical Disability Advisor



References

Cited

Burg, Michael D. "Gastritis." eMedicine Health. Eds. Scott H. Plantz, et al. 10 Aug. 2005. WebMD, LLC. 4 Oct. 2009 <http://www.emedicinehealth.com/gastritis/article_em.htm>.

Cohen, Sidney. "Gastritis." Merck Manual of Diagnosis and Therapy. Jan. 2007. Merck & Co., Inc. 4 Oct. 2009 <http://www.merck.com/mmpe/sec02/ch013/ch013c.html>.

Mukherjee, Sandeep, et al. "Gastritis, Chronic." eMedicine. Eds. Tushar Patel, et al. 24 Aug. 2009. Medscape. 4 Oct. 2009 <http://emedicine.medscape.com/article/176156-overview>.

Sepulveda, Antonia R. "Gastritis, Atrophic." eMedicine. Eds. Gregory William Rutecki, et al. 22 Mar. 2006. Medscape. 4 Oct. 2009 <http://emedicine.medscape.com/article/176036-overview>.

Shayne, Philip. "Gastritis and Peptic Ulcer Disease." eMedicine. Eds. Jeffrey Glenn Bowman, et al. 21 Aug. 2008. Medscape. 4 Oct. 2009 <http://emedicine.medscape.com/article/776460-overview>.

Source: Medical Disability Advisor






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