Acute or chronic gastritis

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A 50-year-old man has been suffering from substernal pain for the last 5 months, particularly on waking up in the morning. He lost his job a year ago and was suffering from depression. He consumes about 12–16 cans of .beer every day. He has lost his appetite too and says that eating aggravates pain.

Is this acute or chronic gastritis?
What factors may lead to the development of gastritis?
What investigation should be performed?
How can the patient be treated?

Sample Solution

Acute or chronic gastritis

There are two types of gastritis, acute and chronic. Acute gastritis is usually caused by an irritant or infection, and can result in an acute upset stomach, but usually settles quickly with simple treatments when the cause is removed. Chronic gastritis is a condition in which the stomach lining is damaged long-term, often due to infection by H. pylori. The patient above is suffering from acute gastritis. Acute gastritis is caused by acute irritants that overwhelm the mucus lining that usually protects the stomach mucosa. Irritants include aspirin, poisons (including alcohol), and certain infections. When acute gastritis symptoms are bad enough to warrant contacting a doctor, a diagnosis is usually able to be made based simply on the story. However, a direct look at the stomach lining via an upper endoscopy examination, also known as EGD. The most important part of treatment is to remove the irritant when found. Simple antacid medicine (Tagamet or Zantac) are helpful for reducing the amount of acid in the stomach.

Now, Harriet’s wording here is important. If a reply to an offer introduces new, different terms not included in the original offer, this will be considered a counter-offer. This was proven in the case of Jones v Daniel, wherein in a letter accepting the offer Jones introduced new terms relating to the date of completion, amongst others. If Harriet had stated that she would accept the offer only if the deadline was extended to the 7th of November, for example, this would have been a counter-offer and not acceptance.

However, she asks if Gerald would perhaps consider extending the date. Inquiring whether the offeror will modify his terms does not necessarily amount to a counter-offer. The legal basis for this is shown in Stevenson, Jacques & Co v McLean: the plaintiffs could still accept the offer of the defendants because they had telegraphed requesting information as to certain possible terms of credit. Therefore it can be argued that Harriet’s text is sufficient acceptance.

Communication of Acceptance

If the wording of Harriet’s text is sufficient acceptance, we must now look to Harriet’s communication of it. There has to be clear communication to the offeror that their offer is accepted. Harriet chooses to text Gerald her acceptance of the offer. Gerald does not check his texts, does not receive her communication, and sells the car to someone else.

The rule for non-instantaneous methods of communication, such as post, is that acceptance is communicated as soon as the letter is posted (the ‘postal rule’, laid down in Adams v Lindsell). However in Entores v Miles Far East, Denning LJ held that for instantaneous methods of acceptance, acceptance occurs when and where the message of acceptance is received.

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