Gastritis

Overview

Gastritis is a general term that refers to inflammation of the stomach lining (gastric mucosa). This common condition can be acute, developing suddenly and lasting for a short time, or chronic, developing gradually and persisting for months or years. The inflammation can range from mild irritation to severe erosion of the stomach lining.

The stomach lining normally protects itself from the acidic environment through a thick mucus barrier. When this protective barrier is weakened or damaged, gastric acid can irritate and inflame the stomach lining, causing gastritis. The most common cause is infection with Helicobacter pylori (H. pylori) bacteria, but other factors including certain medications, alcohol, stress, and autoimmune conditions can also trigger gastritis.

While mild gastritis may cause only minor symptoms or none at all, severe cases can lead to serious complications including peptic ulcers, bleeding, and in rare cases, increased risk of stomach cancer. With proper diagnosis and treatment, most cases of gastritis can be effectively managed and complications prevented.

Symptoms

Gastritis symptoms can vary significantly from person to person. Some people with gastritis have no symptoms at all, while others experience severe discomfort. Symptoms may be intermittent or persistent, and can range from mild to severe.

Common Symptoms

Additional Symptoms

Serious Symptoms

Symptoms by Type

Acute Gastritis: Symptoms develop suddenly and are often more severe, including intense abdominal pain, nausea, vomiting, and sometimes fever.

Chronic Gastritis: Symptoms develop gradually and may be mild or intermittent, including persistent indigestion, loss of appetite, and feeling full after eating small amounts.

Warning Signs

Seek immediate medical attention if you experience:

• Vomiting blood or material that looks like coffee grounds
• Black, tarry stools (melena)
• Severe abdominal pain
• Signs of dehydration
• High fever with stomach pain

Causes

Gastritis has multiple potential causes, all of which result in inflammation of the stomach lining. Understanding these causes is important for both treatment and prevention:

H. pylori Bacterial Infection

Helicobacter pylori is the most common cause of gastritis worldwide, responsible for about 60% of chronic gastritis cases. This spiral-shaped bacterium:

• Colonizes the stomach lining and weakens the protective mucus barrier
• Produces enzymes and toxins that damage stomach tissue
• Can be transmitted through contaminated food, water, or person-to-person contact
• Often causes no symptoms initially but can lead to chronic inflammation

Medications

Certain medications can irritate or damage the stomach lining:

• NSAIDs: Ibuprofen, aspirin, naproxen can reduce protective prostaglandins
• Corticosteroids: Long-term use can increase stomach acid production
• Antibiotics: Can disrupt the balance of stomach bacteria
• Bisphosphonates: Used for osteoporosis, can irritate the stomach
• Chemotherapy drugs: Can cause inflammation throughout the digestive tract

Lifestyle Factors

• Excessive alcohol consumption: Irritates and erodes the stomach lining
• Smoking: Increases stomach acid and reduces protective factors
• Stress: Physical or emotional stress can increase acid production
• Spicy or acidic foods: Can irritate an already inflamed stomach

Other Medical Conditions

• Autoimmune gastritis: Immune system attacks stomach cells
• Crohn's disease: Inflammatory bowel disease affecting the digestive tract
• Bile reflux: Bile backing up into the stomach from the small intestine
• Viral infections: Particularly in immunocompromised patients
• Severe illness or injury: Can cause stress-related gastritis

Rare Causes

• Radiation therapy to the abdomen
• Ingestion of corrosive substances
• Parasitic infections
• Sarcoidosis and other granulomatous diseases

Risk Factors

Several factors increase the likelihood of developing gastritis:

Demographic Factors

• Age: Risk increases with age, particularly for H. pylori infection and autoimmune gastritis
• Geographic location: H. pylori is more common in developing countries
• Socioeconomic status: Lower income associated with higher H. pylori rates

Lifestyle Risk Factors

• Regular NSAID use: Especially in older adults or with long-term use
• Heavy alcohol consumption: Daily drinking or binge drinking
• Smoking: Both current and former smokers have increased risk
• Stress: Chronic stress or acute severe stress
• Poor hygiene: Increases risk of H. pylori transmission

Medical Risk Factors

• H. pylori infection: Primary risk factor for chronic gastritis
• Autoimmune diseases: Type 1 diabetes, thyroid disorders
• HIV/AIDS: Increased susceptibility to infections
• Previous gastric surgery: Alters normal stomach anatomy
• Kidney disease: Requiring dialysis increases risk

Family History

• Family history of H. pylori infection
• Genetic predisposition to autoimmune conditions
• Family history of stomach cancer

Environmental Factors

• Exposure to radiation
• Living in crowded conditions (increases H. pylori transmission)
• Contaminated water supply
• Poor food safety practices

Diagnosis

Diagnosing gastritis involves a combination of medical history, physical examination, and specific tests to determine the cause and severity of inflammation:

Medical History and Physical Exam

Your doctor will ask about:

• Symptoms and their duration
• Medication use, especially NSAIDs
• Alcohol consumption and smoking habits
• Family history of stomach problems
• Recent travel or dietary changes

H. pylori Testing

Several tests can detect H. pylori infection:

• Stool antigen test: Detects H. pylori proteins in stool samples
• Urea breath test: Patient drinks a solution containing labeled carbon, which H. pylori converts to labeled CO2
• Blood antibody test: Detects antibodies against H. pylori (less accurate for current infection)
• Biopsy during endoscopy: Most accurate method for diagnosis

Endoscopic Examination

Upper endoscopy (EGD) is the gold standard for diagnosing gastritis:

• Direct visualization of the stomach lining
• Assessment of inflammation severity
• Biopsy collection for microscopic examination
• Identification of ulcers or other complications
• Testing for H. pylori and cancer cells

Imaging Studies

• Upper GI series (barium swallow): X-rays after drinking contrast material
• CT scan: May be used to evaluate complications
• Ultrasound: Less commonly used for gastritis diagnosis

Laboratory Tests

• Complete blood count: Checks for anemia from bleeding
• Vitamin B12 levels: May be low in chronic gastritis
• Pepsinogen levels: Markers of stomach function
• Gastrin levels: Elevated in certain types of gastritis

Histological Classification

Biopsy samples are examined to classify gastritis:

• Acute gastritis: Neutrophil infiltration
• Chronic gastritis: Lymphocyte and plasma cell infiltration
• Atrophic gastritis: Loss of gastric glands
• Metaplastic gastritis: Abnormal cell changes

Treatment Options

Treatment for gastritis depends on the underlying cause, severity of symptoms, and presence of complications. The goals are to reduce inflammation, eliminate underlying causes, and prevent complications.

H. pylori Eradication Therapy

If H. pylori is present, triple or quadruple therapy is typically used:

Triple Therapy (10-14 days):

• Proton pump inhibitor (PPI)
• Clarithromycin
• Amoxicillin or metronidazole

Quadruple Therapy (10-14 days):

• Proton pump inhibitor (PPI)
• Bismuth subsalicylate
• Metronidazole
• Tetracycline

Acid-Suppressing Medications

• Proton Pump Inhibitors (PPIs): Omeprazole, lansoprazole, esomeprazole
• H2 Receptor Blockers: Ranitidine, famotidine, cimetidine
• Antacids: For immediate symptom relief

Protective Agents

• Sucralfate: Forms a protective barrier over ulcers
• Misoprostol: Prostaglandin analog that protects stomach lining
• Bismuth compounds: Provide protective coating

Lifestyle Modifications

• Dietary changes:
  • Avoid spicy, acidic, or fatty foods
  • Eat smaller, more frequent meals
  • Limit coffee and alcohol
  • Include probiotics and anti-inflammatory foods
• Medication adjustments:
  • Discontinue NSAIDs if possible
  • Use alternative pain relievers (acetaminophen)
  • Take medications with food when recommended
• Lifestyle habits:
  • Stop smoking
  • Limit alcohol consumption
  • Manage stress through relaxation techniques
  • Maintain good hygiene to prevent reinfection

Treatment of Specific Types

Autoimmune Gastritis:

• Vitamin B12 supplementation
• Iron supplementation if anemic
• Regular monitoring for complications

NSAID-Induced Gastritis:

• Discontinue NSAIDs if possible
• Switch to selective COX-2 inhibitors
• Co-prescribe PPIs with NSAIDs

Monitoring and Follow-up

• Symptoms assessment
• H. pylori eradication testing
• Endoscopic surveillance in high-risk patients
• Monitoring for complications

Prevention

While not all cases of gastritis can be prevented, many risk factors are modifiable through lifestyle changes and proper medical management:

H. pylori Prevention

• Good hygiene practices:
  • Wash hands thoroughly with soap and water
  • Ensure food is completely cooked
  • Drink water from safe, clean sources
  • Avoid sharing eating utensils
• Food safety:
  • Properly wash fruits and vegetables
  • Avoid raw or undercooked foods
  • Be cautious when traveling to areas with poor sanitation

Medication-Related Prevention

• NSAID use:
  • Use the lowest effective dose for the shortest duration
  • Take NSAIDs with food
  • Consider gastroprotective agents (PPIs) for high-risk patients
  • Use alternative pain relievers when possible
• Other medications:
  • Follow prescribed dosing instructions
  • Report stomach symptoms to healthcare providers
  • Don't abruptly stop medications without medical supervision

Lifestyle Prevention Strategies

• Dietary habits:
  • Maintain a balanced, nutritious diet
  • Limit spicy, acidic, and fatty foods
  • Eat regular meals and avoid skipping meals
  • Limit caffeine and alcohol consumption
• Stress management:
  • Practice relaxation techniques
  • Regular exercise
  • Adequate sleep
  • Seek support for chronic stress
• Harmful substances:
  • Don't smoke or quit smoking
  • Limit alcohol consumption
  • Avoid recreational drugs

Regular Medical Care

• Regular check-ups, especially if at high risk
• Screening for H. pylori in endemic areas
• Management of underlying conditions
• Monitoring during long-term medication use

High-Risk Individuals

People at higher risk should consider:

• More frequent medical monitoring
• Prophylactic treatment in certain circumstances
• Family screening for H. pylori
• Genetic counseling for autoimmune gastritis

When to See a Doctor

While mild stomach discomfort is common and often resolves on its own, certain symptoms warrant medical evaluation:

Seek Immediate Emergency Care

• Vomiting blood or material that looks like coffee grounds
• Black, tarry stools (melena) indicating upper gastrointestinal bleeding
• Severe abdominal pain that is sudden or worsening
• Signs of severe dehydration: dizziness, dry mouth, little or no urination
• High fever (over 101°F/38.3°C) with abdominal pain
• Chest pain that could indicate heart problems
• Difficulty swallowing or persistent vomiting

Schedule an Appointment Soon

• Persistent stomach pain lasting more than a week
• Recurrent nausea and vomiting
• Loss of appetite leading to weight loss
• Symptoms that interfere with daily activities
• Burning sensation in the stomach, especially after eating
• Feeling full after eating small amounts
• Frequent indigestion not relieved by over-the-counter medications

Routine Consultation Recommended

• Risk factors for gastritis: Long-term NSAID use, heavy alcohol consumption
• Family history of stomach problems or H. pylori infection
• Recent travel to areas with poor sanitation and developing stomach symptoms
• Taking medications known to cause stomach irritation
• Chronic conditions that increase gastritis risk

Follow-up Care

If you've been diagnosed with gastritis, see your doctor if:

• Symptoms don't improve with treatment
• Symptoms worsen or new symptoms develop
• You complete H. pylori treatment (for eradication testing)
• You develop side effects from medications
• You have concerns about long-term management

Preparing for Your Appointment

• Keep a symptom diary noting triggers and timing
• List all medications, including over-the-counter drugs and supplements
• Note dietary habits and alcohol consumption
• Prepare questions about treatment options and lifestyle changes
• Bring a list of family medical history

Related Conditions

Gastritis is associated with several complications and related gastrointestinal conditions:

Complications of Gastritis

• Gastrointestinal bleeding: From erosions or ulcers
• Atrophic gastritis: Loss of gastric glands leading to malabsorption
• Gastric outlet obstruction: Narrowing of the passage from stomach to small intestine
• Perforation: Rare but serious hole in the stomach wall

Associated Conditions

• Irritable Bowel Syndrome (IBS)
• Inflammatory Bowel Disease
• Functional Dyspepsia
• Gallbladder Disease
• Pancreatitis

Conditions That Mimic Gastritis

• Myocardial Infarction (heart attack symptoms can mimic gastritis)
• Appendicitis (can sometimes present with upper abdominal pain)
• Liver Disease
• Kidney Stones

Frequently Asked Questions

References

1. Rugge, M., et al. Gastritis: update on etiological features and histological patterns. Digestive and Liver Disease. 2019.
2. Malfertheiner, P., et al. Management of Helicobacter pylori infection—the Maastricht V Consensus Report. Gut. 2017.
3. Sonnenberg, A., & Genta, R. M. Prevalence of Helicobacter pylori in the United States. Alimentary Pharmacology & Therapeutics. 2018.
4. Sugano, K., et al. Kyoto global consensus report on Helicobacter pylori gastritis. Gut. 2015.
5. American Gastroenterological Association. AGA Clinical Practice Guidelines on the Role of Probiotics in the Management of Gastrointestinal Disorders. Gastroenterology. 2020.