Gastritis

What happens in gastritis

The stomach lining protects itself from acid with a layer of mucus, bicarbonate and good blood flow. Prostaglandins, natural chemicals made in the lining, keep these defenses working. Gastritis occurs when infection, chemicals or the immune system damage this barrier, allowing acid to injure the lining. Inflammation can range from mild redness to erosions (shallow breaks) and, if deeper, ulcers.

Doctors sometimes use the term gastropathy when the lining is damaged with little inflammation, as with NSAIDs or bile reflux.

Types of gastritis

Atrophic gastritis, a long-term thinning of the lining, can follow H. pylori or autoimmune gastritis and raises the risk of stomach cancer.

Symptoms

• burning, gnawing or aching pain in the upper middle belly
• pain that may improve or worsen with eating
• nausea and sometimes vomiting
• bloating and belching
• feeling full after a few bites
• loss of appetite

Many people with chronic gastritis have no symptoms. Bleeding from erosive gastritis can cause black stools (melena), vomiting blood, or slowly developing anemia with tiredness and breathlessness.

Causes and risk factors

• H. pylori infection: the most common cause of chronic gastritis worldwide.
• NSAIDs and aspirin: even low-dose aspirin; risk is higher with age over 65, higher doses, combination with steroids, blood thinners or SSRIs, and previous ulcers.
• Alcohol: heavy drinking irritates the lining.
• Smoking.
• Severe physical stress: major surgery, burns, trauma or intensive care.
• Autoimmune disease: type 1 diabetes, Hashimoto's thyroiditis.
• Bile reflux.
• Older age: the lining thins naturally.

Spicy foods and everyday stress do not cause gastritis, though they can worsen symptoms in some people.

Diagnosis

• H. pylori tests: urea breath test, stool antigen test, or biopsy during endoscopy. Stop PPIs for 2 weeks and antibiotics or bismuth for 4 weeks before breath or stool tests, if possible, to avoid false negatives.
• Upper endoscopy: a camera looks at the stomach lining and takes biopsies. Recommended for alarm features, age over about 60 with new symptoms, or symptoms that do not respond to treatment.
• Blood tests: blood count for anemia, B12 levels, and antibodies for autoimmune gastritis.

Treatment

Remove the cause

• Stop or reduce NSAIDs if possible; acetaminophen (paracetamol) is gentler on the stomach. If you must take NSAIDs or aspirin, your doctor may add a PPI.
• Limit alcohol and stop smoking.
• Eradicate H. pylori with combination antibiotic therapy. See H. pylori testing and treatment.

Reduce stomach acid

• Proton pump inhibitors (PPIs): omeprazole, pantoprazole and others; usually taken for 4 to 8 weeks.
• H2 blockers: famotidine.
• Antacids: for short-term symptom relief.

Autoimmune gastritis

Vitamin B12 injections or high-dose tablets, iron if needed, and endoscopic surveillance in some people.

Diet and lifestyle

There is no single gastritis diet, but these help many people:

• eat smaller, more frequent meals
• avoid foods that clearly worsen your symptoms, often fatty, fried or very spicy foods, caffeine, carbonated drinks and alcohol
• do not eat within 2 to 3 hours of bedtime
• stop smoking

Complications

• peptic ulcers
• bleeding and iron-deficiency anemia
• vitamin B12 deficiency and pernicious anemia in autoimmune gastritis
• atrophic gastritis and intestinal metaplasia
• stomach cancer and gastric MALT lymphoma, linked to long-term H. pylori infection

How long gastritis lasts

Acute gastritis from alcohol or NSAIDs often improves within days of stopping the irritant and starting acid suppression. Chronic H. pylori gastritis improves after the infection is cleared, though the lining can take months to recover. Autoimmune gastritis is lifelong.

Frequently asked questions

What are the symptoms of gastritis?

Common symptoms are a burning or gnawing pain in the upper belly, nausea, bloating, belching, loss of appetite and feeling full quickly. Many people have no symptoms. Black stools or vomiting blood are signs of bleeding and need emergency care.

What causes gastritis?

The most common causes are Helicobacter pylori infection, regular use of NSAIDs or aspirin, and heavy alcohol use. Severe physical stress, autoimmune disease and bile reflux can also cause it.

How is gastritis treated?

Treatment depends on the cause. It includes stopping NSAIDs and alcohol, taking acid-reducing medicines such as PPIs, and treating H. pylori with a combination of antibiotics. Autoimmune gastritis needs vitamin B12 replacement.

What should I eat with gastritis?

Choose smaller meals and foods that do not worsen your symptoms. Many people do better avoiding alcohol, fatty or fried foods, very spicy foods, caffeine and carbonated drinks. Diet eases symptoms but does not replace treatment of the cause.

Can gastritis go away on its own?

Mild acute gastritis can settle within days once the irritant is removed. Chronic gastritis from H. pylori usually persists until the infection is treated. Persistent symptoms should be evaluated rather than self-treated long term.

Can stress cause gastritis?

Everyday emotional stress does not directly cause gastritis but can worsen symptoms. Severe physical stress, such as major surgery, burns or critical illness, can cause stress gastritis, which is why hospitals often give acid-reducing medicines to very ill patients.