Chronic Gastritis

Acute vs chronic gastritis

Gastritis means inflammation of the stomach lining. Acute gastritis develops suddenly, for example after alcohol or NSAIDs, and often settles in days. Chronic gastritis develops slowly and persists. Over many years, chronic inflammation can lead to atrophic gastritis, in which the stomach's glands are lost and replaced, sometimes by intestinal-type cells (intestinal metaplasia).

Causes

Helicobacter pylori infection

H. pylori is a spiral bacterium that lives in the stomach lining. It is usually acquired in childhood and infects a large share of the world's population, though rates are lower in the US. It causes chronic gastritis in nearly everyone infected, and is the main cause of peptic ulcers and stomach cancer.

Autoimmune gastritis

The immune system attacks the acid-producing cells of the stomach body. This reduces acid and intrinsic factor, a protein needed to absorb vitamin B12. It can lead to pernicious anemia and vitamin B12 deficiency, as well as iron deficiency. It is more common in people with thyroid disease or type 1 diabetes.

Chemical (reactive) gastropathy

• NSAIDs: ibuprofen, naproxen and aspirin damage the protective lining.
• Alcohol: heavy, regular drinking.
• Bile reflux: bile flowing back into the stomach, especially after stomach surgery.

Less common causes

Crohn's disease, eosinophilic gastritis, infections in people with weakened immunity, and radiation.

Symptoms

Many people have none. When present, symptoms include:

• burning or gnawing upper abdominal pain
• bloating and belching
• nausea
• feeling full quickly or after small meals
• loss of appetite

Symptoms of complications:

• tiredness, pale skin and breathlessness from anemia
• numbness, tingling, balance problems or memory issues from B12 deficiency
• black stools or vomiting blood from bleeding

Diagnosis

• H. pylori tests: a urea breath test or stool antigen test. Stop proton pump inhibitors 2 weeks and antibiotics 4 weeks before testing if possible, as they can cause false negatives.
• Upper endoscopy (EGD): a thin camera examines the stomach. Biopsies confirm gastritis, identify H. pylori, and detect atrophy, intestinal metaplasia or cancer. Endoscopy is recommended for alarm symptoms or age over about 60 with new symptoms.
• Blood tests: blood count, iron, vitamin B12, and for autoimmune gastritis, antibodies to parietal cells or intrinsic factor.

Treatment

Treating H. pylori

Eradication therapy combines acid suppression with two or more antibiotics, usually for 14 days. A common first choice in the US is bismuth quadruple therapy: a proton pump inhibitor (PPI), bismuth, tetracycline and metronidazole. Other regimens use different antibiotic combinations or vonoprazan. Take every dose; incomplete courses fuel resistance. A breath or stool test at least 4 weeks after finishing confirms the infection is gone.

Reducing acid and protecting the lining

• PPIs such as omeprazole, or H2 blockers such as famotidine, reduce acid and let the lining heal.
• Antacids give short-term relief.

Removing triggers

• Stop or reduce NSAIDs. Use acetaminophen (paracetamol) for pain instead where suitable. If you need aspirin for your heart, do not stop it without your doctor, who may add a PPI.
• Reduce or stop alcohol, and stop smoking.

Autoimmune gastritis

Vitamin B12 replacement, by injection or high-dose tablets, and iron if needed. People with atrophic gastritis may be offered surveillance endoscopy every few years, depending on severity and risk factors.

Diet for chronic gastritis

No single diet cures gastritis, but these steps often ease symptoms:

• eat smaller, more frequent meals
• avoid foods that consistently worsen your symptoms, commonly spicy, fatty or fried foods, citrus, tomato, coffee and carbonated drinks
• limit alcohol
• avoid eating within 2 to 3 hours of bedtime
• include fiber-rich foods, fruits, vegetables and lean proteins as tolerated

Complications

• peptic ulcers and bleeding
• iron deficiency and B12 deficiency anemia
• atrophic gastritis and intestinal metaplasia
• stomach cancer and, with H. pylori, MALT lymphoma (rare)

Outlook

Gastritis caused by H. pylori or NSAIDs usually improves after the cause is removed, and the stomach lining can heal. Eradicating H. pylori lowers the risk of ulcers and stomach cancer. Atrophic changes heal slowly or not at all, so some people need long-term monitoring.

Frequently asked questions

What are the symptoms of chronic gastritis?

Many people have no symptoms. When they occur, symptoms include a burning or aching upper abdomen, bloating, nausea, belching, loss of appetite and feeling full quickly. Anemia or black stools can signal complications.

Can chronic gastritis be cured?

Often, yes. Gastritis from H. pylori usually resolves after successful antibiotic treatment, and gastritis from NSAIDs or alcohol improves when they are stopped. Autoimmune and advanced atrophic gastritis are long-term but manageable with vitamin replacement and monitoring.

What should I eat with chronic gastritis?

Eat smaller, regular meals and avoid foods and drinks that trigger your symptoms, often spicy and fatty foods, coffee, alcohol, citrus and fizzy drinks. A balanced diet with vegetables, whole grains and lean proteins is usually well tolerated.

Does chronic gastritis increase cancer risk?

Chronic H. pylori infection and atrophic gastritis with intestinal metaplasia increase the risk of stomach cancer, though most people never develop it. Eradicating H. pylori and surveillance endoscopy in higher-risk people reduce the risk.