Chronic Gastritis

Overview

Gastritis is inflammation of the lining of the stomach. When this inflammation develops slowly and persists over a long period, it is called chronic gastritis. Unlike acute gastritis, which comes on suddenly, chronic gastritis can build up gradually over months or years and may cause few or no symptoms for a long time.

The stomach lining normally protects itself from the strong acid it produces. In chronic gastritis, this lining is repeatedly or continuously irritated and inflamed, most often by infection with the bacterium Helicobacter pylori (H. pylori) or by long-term irritants such as pain medicines and alcohol. Over many years, ongoing inflammation can thin the lining and, in some people, raise the risk of ulcers and other stomach problems. With diagnosis and treatment of the underlying cause, chronic gastritis can usually be managed effectively.

Symptoms

Many people with chronic gastritis have mild symptoms or none at all. When symptoms occur, they may include:

• A gnawing or burning ache or pain in the upper abdomen
• A feeling of fullness in the upper abdomen after eating
• Indigestion, bloating, or belching
• Nausea and, occasionally, vomiting
• Loss of appetite

Long-standing gastritis can sometimes interfere with the absorption of vitamin B12 and iron, leading to anemia and symptoms such as fatigue and weakness. Vomiting blood or material that looks like coffee grounds, or passing black, tarry stools, can indicate bleeding and requires emergency care.

Causes

Chronic gastritis results from persistent irritation or damage to the stomach lining. Common causes include:

• H. pylori infection: The leading cause worldwide, this common bacterium can quietly inflame the stomach lining for years.
• Long-term NSAID use: Regular use of pain relievers such as ibuprofen, naproxen, and aspirin can wear down the lining's defenses.
• Alcohol: Frequent heavy drinking irritates and inflames the lining.
• Autoimmune gastritis: The immune system attacks the cells of the stomach lining, which can reduce stomach acid and affect vitamin B12 absorption.
• Bile reflux: Backflow of bile from the small intestine into the stomach.

Older age, stress from serious illness, and certain other infections can also contribute to ongoing inflammation.

Risk Factors

• H. pylori infection
• Frequent or long-term use of NSAID pain relievers
• Heavy or regular alcohol use
• Older age, as the stomach lining thins over time
• Smoking
• Autoimmune conditions, especially for autoimmune gastritis
• Long-term stress from serious illness or surgery

Diagnosis

Doctors diagnose chronic gastritis using a combination of history and tests aimed at confirming inflammation and finding its cause:

• H. pylori testing: Breath, stool, or blood tests to detect the bacterium
• Upper endoscopy: A thin camera passed through the mouth to view the stomach lining and take small biopsies
• Biopsy: Examining tissue samples to confirm inflammation, detect H. pylori, and check for other changes
• Blood tests: To check for anemia and vitamin B12 levels, particularly in autoimmune gastritis

Treatment

Treatment focuses on removing the cause, reducing acid so the lining can heal, and managing symptoms.

• Treating H. pylori: A combination of antibiotics with an acid-reducing medicine clears the infection, which often resolves the gastritis.
• Acid-reducing medicines: Proton pump inhibitors or H2 blockers lower stomach acid and ease symptoms while the lining heals.
• Stopping irritants: Reducing or avoiding NSAIDs and alcohol, and using a stomach-protecting medicine if NSAIDs must be continued.
• Vitamin replacement: B12 or iron supplements when absorption is affected, especially in autoimmune gastritis.

Most people improve once the cause is addressed. Because long-standing inflammation can occasionally lead to other stomach changes, doctors sometimes recommend follow-up, particularly in autoimmune or persistent cases.

Prevention

• Use NSAIDs only when needed, at the lowest effective dose, and with food
• Ask about acid-reducing medicine if you must take NSAIDs regularly
• Limit alcohol and avoid smoking
• Get tested and treated for H. pylori if you have ongoing stomach symptoms or a history of ulcers
• Eat regular, balanced meals and manage stress where possible

When to See a Doctor

See a doctor for ongoing upper abdominal discomfort, indigestion, nausea, or loss of appetite that lasts more than a week or keeps returning, or if you feel unusually tired, which can suggest anemia. Seek emergency care if you vomit blood or material that looks like coffee grounds, pass black or tarry stools, or have sudden, severe abdominal pain, as these can indicate bleeding or another serious complication.

Related Topics

Frequently Asked Questions

References

1. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Gastritis & Gastropathy.
2. Mayo Clinic. Gastritis — Symptoms and causes.
3. MedlinePlus, U.S. National Library of Medicine. Gastritis.
4. American College of Gastroenterology. H. pylori and Peptic Ulcer Disease.