Atrophic Gastritis

Overview

Atrophic gastritis is a long-lasting form of inflammation in which the stomach lining gradually becomes thin and the specialized cells that produce stomach acid and digestive enzymes are lost. As these cells disappear, the stomach makes less acid and may not absorb certain nutrients, particularly vitamin B12, as well as it should.

There are two main forms. One is caused by long-term infection with the bacterium Helicobacter pylori, and the other is an autoimmune form in which the immune system attacks the stomach's own lining cells. Atrophic gastritis often develops slowly over years and may cause few symptoms at first. Because long-standing changes in the stomach lining can modestly raise the risk of stomach cancer and lead to anemia, the condition is monitored and managed rather than ignored.

Symptoms

Many people with atrophic gastritis have mild or no symptoms, and the condition is often found during tests for other problems. When symptoms occur they may include:

• Upper abdominal discomfort, fullness, or a burning feeling
• Nausea, bloating, or reduced appetite
• Fatigue and weakness, often from vitamin or iron deficiency
• Symptoms of anemia, such as pale skin, shortness of breath, or a fast heartbeat
• Tingling or numbness in the hands and feet from vitamin B12 deficiency
• A sore or smooth tongue in some cases

Because nutrient deficiencies develop slowly, their effects can be the first noticeable signs.

Causes

Atrophic gastritis has two main causes.

• H. pylori infection: Long-term infection with this bacterium inflames and gradually damages the stomach lining, which is the most common cause worldwide.
• Autoimmune disease: The immune system mistakenly attacks the acid-producing cells of the stomach and a protein needed to absorb vitamin B12. This form is often associated with other autoimmune conditions.

Over time, either process thins the lining and reduces acid and enzyme production, and the autoimmune form in particular can lead to a specific kind of anemia.

Risk Factors

• Long-term H. pylori infection
• A personal or family history of autoimmune conditions, such as thyroid disease or type 1 diabetes
• Older age
• A family history of atrophic gastritis or pernicious anemia
• Certain ancestries with higher rates of H. pylori

Diagnosis

Diagnosis usually involves looking at the stomach lining directly and testing for causes and consequences.

• Upper endoscopy with biopsy: A camera examines the stomach and small tissue samples confirm thinning of the lining and look for precancerous changes.
• H. pylori testing: Breath, stool, blood, or biopsy tests to detect the bacterium.
• Blood tests: To check for vitamin B12 deficiency, iron levels, anemia, and antibodies associated with the autoimmune form.

Treatment

Treatment depends on the cause and on correcting any nutrient deficiencies.

• Treating H. pylori: A course of antibiotics with an acid-reducing medicine clears the infection and can halt further damage.
• Vitamin B12 replacement: Often given by injection or high-dose supplements when absorption is impaired, especially in the autoimmune form.
• Iron supplements: If iron-deficiency anemia is present.
• Monitoring: Periodic endoscopy may be advised to watch for precancerous changes, since the risk of stomach cancer is somewhat increased.
• Managing related conditions: Checking for and treating associated autoimmune diseases.

Prevention

Not all cases can be prevented, especially the autoimmune form, but some steps help.

• Get tested and treated for H. pylori, particularly if you have ongoing stomach symptoms or a family history of stomach cancer
• Maintain good food and water hygiene to reduce H. pylori exposure
• Keep up with recommended monitoring if you have been diagnosed
• Address vitamin and iron deficiencies early with your doctor's guidance

When to See a Doctor

See a doctor if you have ongoing upper abdominal discomfort, unexplained fatigue, or symptoms of anemia such as pale skin and breathlessness, or tingling in the hands and feet. Seek prompt care for:

• Vomiting blood or material that looks like coffee grounds
• Black, tarry stools
• Unintended weight loss, difficulty swallowing, or persistent vomiting

Related Topics

Frequently Asked Questions

References

1. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Gastritis.
2. Mayo Clinic. Gastritis.
3. MedlinePlus, U.S. National Library of Medicine. Atrophic gastritis.
4. American Cancer Society. Stomach cancer risk factors.