Gastritis

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What is gastritis?

Gastritis is inflammation and irritation of the stomach lining, or mucosa. Normally, the stomach lining has a protective layer to shield it from the effects of normal stomach acid. The irritation and inflammation of gastritis make the stomach lining more vulnerable to the acidity inside the stomach. This can result in abdominal pain, loss of appetite, and possibly bleeding.

Gastritis can be acute, coming and going quickly, or chronic, in which case the disease can last months or even years. Acute gastritis is the most common form in the United States. About 8 in 1,000 Americans will get acute gastritis. Chronic gastritis is less common, affecting about 1 in 10,000 Americans.

Gastritis can also fall into one of the following categories based on the extent of injury to the stomach lining:

  • Erosive, which means the inflammation wears away the stomach lining, eventually causing lesions or ulcers. It is usually a form of acute gastritis that develops suddenly. It is a more serious form of gastritis compared to nonerosive gastritis. Gastrointestinal bleeding is more common with erosive gastritis.
  • Nonerosive, which means the lining is not worn away, but it can degenerate, or atrophy. The lining can also undergo a process called metaplasia. This means it turns into a different type of tissue, usually intestinal tissue. The inflammation can affect all of the stomach or just parts of it. Nonerosive gastritis is usually a form of chronic gastritis and is often asymptomatic (no symptoms).

Causes of erosive gastritis most commonly include alcohol use, tobacco use, and prolonged use of aspirin and NSAIDS (nonsteroidal anti-inflammatory drugs). Severe illness and consumption of caustic substances have also been associated with the development of erosive gastritis.

The most common cause of chronic, nonerosive gastritis is a stomach infection with Helicobacter pylori (H. pylori). H. pylori is a type of bacteria found in up to half of all people in industrialized nations. In the United States, about 35% of the population has the infection. The incidence of H. pylori infection increases with age.

The signs and symptoms of gastritis can be constant or sporadic, and the disease course varies among individuals. If infection with H. pylori bacteria is the cause, gastritis symptoms will remain as long as the infection is untreated. Some people with gastritis have no symptoms. Others have burning abdominal pain, nausea, vomiting and other digestive—or gastrointestinal (GI)—symptoms.

In the case of H. pylori-related gastritis, the infection can be treated successfully with antibiotics. Usually, doctors prescribe at least two antibiotics plus an acid-blocking drug. For gastritis not due to H. pylori, medications that reduce stomach acid can be an effective treatment. This includes proton pump inhibitors (PPIs), H2 blockers, and antacids.

You can reduce your risk of H. pylori infection by following commonsense hygiene practices, such as washing your hands regularly with soap and water. Lifestyle changes, such as limiting alcohol consumption and the use of NSAIDs, can reduce the risk of gastritis that is not related to H. pylori.

Seek immediate medical care (call 911) for serious gastritis symptoms, such as severe abdominal pain; bloody or black, tarry stools; or bloody or black vomit. Seek prompt medical care if you are being treated for gastritis, but mild symptoms recur or are persistent.

What are the symptoms of gastritis?

Gastritis causes inflammation and swelling of the stomach lining that can result in a number of symptoms. The symptoms can vary in intensity among individuals. However, some people with gastritis, especially nonerosive gastritis, do not have any symptoms. With nonerosive gastritis, symptoms can be vague.

Common symptoms of gastritis

You may experience gastritis symptoms daily or just once in a while. Gastritis symptoms may get better with food or food may make them worse. At times, any of these common symptoms can be severe:

  • Bloating or a sense of feeling too full or feeling full too soon
  • Nausea with or without vomiting
  • Upper abdominal burning or gnawing
  • Upper abdominal pain, discomfort or achiness

When gastritis is erosive, it can lead to ulcers that can slowly bleed. With time, the loss of blood can eventually cause anemia—or low red blood cells. Symptoms of anemia include fatigue, dizziness, pale skin, shortness of breath with activity, and cold hands and feet.

Serious symptoms that might indicate a life-threatening condition

In some cases, gastritis can lead to potentially life-threatening complications. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

  • Severe abdominal pain

How do you know if stomach pain is serious?

Stomach pain and indigestion are common. Most everyone has experienced them at some point. Usually, the symptoms do not last long and you can manage them with over-the-counter remedies. Stomach pain, discomfort or upset may indicate a potentially serious condition if it lasts for more than a week.

See your doctor for persistent symptoms. You should also contact your doctor if you are having stomach pain or symptoms after taking medicines, either prescription or over-the-counter. Seek care right away if you have bloody vomit, bloody stools, or black stools.

How can you tell the difference between pancreatitis vs. gastritis?

Several conditions have symptoms similar to gastritis. Pancreatitis is one of them, as is gallstones, Crohn’s disease, and peptic ulcer disease. Like gastritis, pancreatitis can cause upper abdominal pain, nausea and vomiting. If you have persistent stomach pain, your doctor will need to rule out these other conditions. Often, a blood test can show if your pancreatic enzyme levels are high or not. Imaging exams can also be helpful to look for gallstones, which are the most common cause of pancreatitis.

What causes gastritis?

There are several types of gastritis with different causes including:

  • Acute stress gastritis, which is a form of erosive gastritis. It occurs with a sudden illness or injury that does not have to involve the stomach itself. Researchers remain uncertain about the exact reason this happens, but it is likely related to overall stress on the body. It affects about 5% of critically ill patients. The longer the ICU (intensive care unit) stay, the higher the risk of developing acute stress gastritis.
  • Autoimmune gastritis, which happens when the body’s immune system mistakenly starts attacking healthy cells in the stomach lining
  • Erosive gastritis, which has several causes. The most common causes include irritation from alcohol, aspirin, NSAIDS and stress.
  • H. pylori gastritis, which is the most common cause of chronic nonerosive gastritis. Experts do not fully understand how infection with this bacterium spreads. It is an extremely common infection. However, not everyone with the infection goes on to develop gastritis or other problems, such as stomach ulcers. It may be that certain people are more susceptible to stomach disease from the infection due to genetics or lifestyle factors. Gastritis due to another infectious pathogen is rare in healthy people. People with impaired immune systems, such as those with HIV or cancer, may develop gastritis from viral or fungal infections.

Other gastritis causes include bile reflux, celiac disease, chronic vomiting, food allergies, chemotherapy, radiation therapy, stomach surgery, and inflammatory diseases, such as Crohn’s disease and sarcoidosis. Injury from procedures, such as placing a nasogastric tube, can also cause gastritis.

What are the risk factors for gastritis?

A number of factors increase the risk of developing gastritis. Not all people with risk factors will get gastritis.

Risk factors for gastritis include:

  • Alcohol abuse or excessive alcohol consumption. Alcohol is irritating to the stomach lining. Chronic or excessive alcohol use can eventually lead to erosive gastritis.
  • Autoimmune diseases. Having an autoimmune disorder, including type 1 diabetes or Hashimoto’s disease, increases the risk of developing autoimmune gastritis.
  • Chronic use of NSAIDs, such as ibuprofen (Advil, Motrin) or naproxen (Aleve), or aspirin. These drugs increase the risk of both acute and chronic gastritis by inhibiting a substance that protects the stomach lining.
  • H. pylori bacterial infection. The incidence of this infection increases with age. In the United States, about 10 to 15% of children under the age of 12 have H. pylori infection. However, up to 60% of adults older than 60 years have the infection. The risk of infection is higher in African Americans, Hispanics and Latinos, American Indians, and Native Alaskans.
  • Older age. Aging leads to thinning of the stomach lining, which increases the risk of gastritis. The incidence of H. pylori infection and autoimmune diseases also increases with age.
  • Smoking and tobacco use. Tobacco products and nicotine may increase vulnerability to infection with H. pylori and the development of gastritis from it.

Reducing your risk of gastritis

It is not entirely clear if you can reduce your risk of contracting H. pylori, the most common cause of chronic gastritis. Experts believe it may spread from person to person or by consuming contaminated food or water. Practicing good hygiene can help protect against infections in general. This includes washing your hands regularly, especially before eating. Practice food safety by eating foods that are thoroughly cooked and kept at a safe temperature.

Other steps you can take to help lower your risk of gastritis include:

  • Limiting alcoholic beverages and seeking help for alcohol abuse or addiction. Avoid drinking on an empty stomach, enjoy your drink with some food
  • Stopping smoking or tobacco use
  • Using NSAIDs and aspirin for short-term pain or symptom relief unless you are under a doctor’s care and see your doctor regularly

If you have risk factors for gastritis, talk with your doctor about your stomach health. Ask about ways to protect your stomach from damage. If you take aspirin or NSAIDs on a regular basis, tell your doctor if you have symptoms after taking a dose. Find out if you should be taking an acid-blocking drug with your NSAID.

Is gastritis triggered or helped by diet?

Food and diet do not cause gastritis in most cases, but foods and drinks can affect gastritis symptoms.

Foods that trigger gastritis

Some people find that certain foods trigger gastritis pain and symptoms. Keeping a food diary can help you identify foods that are problematic for you. Typically, people tend to get a gastritis flare-up from foods that are spicy, greasy, fatty, or very acidic. This includes fried foods, citrus juices, tomato-based foods and juices, coffee, and colas. Milk can also be problematic. Although it may settle your stomach at first, milk stimulates stomach acid production and can worsen symptoms in the long-run.

Foods that help gastritis

Foods that may help gastritis include apples, cranberries and yogurt. These foods have components that may inhibit the growth of H. pylori. Apples and cranberries contain flavonoids, which are antioxidants. Yogurt contains probiotics, which are “good bacteria” that support gut health. Other foods with probiotics include kefir, kimchi and sauerkraut.

What is the link between alcoholism and gastritis?

In addition to the immediate dangers of alcohol use, alcoholism can lead to a variety of chronic diseases, such as liver cirrhosis and gastritis. In fact, chronic alcohol consumption is one of the common causes of erosive gastritis.

Erosive gastritis is a potentially serious and even life-threatening condition. As continued alcohol use irritates and erodes the stomach lining, the risk of serious complications increases. In addition, people with alcoholic gastritis have an increased incidence of vomiting. This combination of gastritis and vomiting can lead to esophageal tears and upper gastrointestinal (GI) bleeding, which can be fatal. Stomach perforation can also occur, which results in stomach acid and contents spilling into the abdominal cavity. This condition can also be fatal.

The incidence of gastritis among people who drink chronically is high. Research suggests nearly everyone with a chronic drinking problem for more than 10 years has gastritis. The first step in treating alcoholic gastritis is to remove the irritant. Stopping drinking can be a challenge. Often, a professional rehabilitation program is necessary. In some cases, the damage is reversible with treatment and alcohol cessation. However, there may be irreversible damage that requires lifelong treatment of chronic gastritis.

How is gastritis treated?

Treatment for gastritis begins with seeking medical care from your healthcare provider. To determine if you have gastritis, your provider may ask you to undergo diagnostic tests. This may include any of the following tests:

  • H. pylori detection tests, which involve a breath test, blood test, or stool test depending on your circumstances
  • Upper endoscopy, which involves passing an endoscope down your throat to examine your esophagus, stomach, and small intestine
  • Upper GI series, which involves drinking barium and taking X-rays of your upper digestive tract. Another name for this test is a barium swallow.

Your gastritis treatment will depend on the underlying cause and the results of diagnostic testing. If your gastritis is related to a drug or substance, your symptoms may resolve by discontinuing it. For gastritis from alcohol, this may require a rehabilitation program. For NSAID-induced gastritis, your doctor will work with you to find a solution to reduce your symptoms. This may mean adding a gastroprotective drug, such as a proton pump inhibitor (PPI), to your NSAID regimen or changing to a selective COX-2 inhibitor, such as celecoxib (Celebrex).

In some cases, there is no clear cause of gastritis. For unexplained gastritis, seeking a second opinion from another healthcare professional may be beneficial.

Antibiotic treatments for gastritis

If your gastritis is due to H. pylori infection, antibiotic therapy is the mainstay of treatment. Most commonly, doctors prescribe two or more antibiotics for 14 days. Usually, doctors add a PPI drug to this antibiotic combination. In some cases, doctors may also recommend taking bismuth subsalicylate (Pepto-Bismol), a mild antacid that also protects the stomach lining.

Examples of antibiotics for H. pylori treatment include:

  • Clarithromycin (Biaxin)
  • Metronidazole (Flagyl)
  • Tetracycline (Achromycin V, Sumycin)

It is important to follow your antibiotic regimen precisely to avoid re-infection or recurrence. Be sure to finish the entire course as prescribed. If you have side effects, contact your doctor to find out whether to keep taking the antibiotics or not.

Other gastroprotective medications to treat gastritis

Gastroprotective medications help reduce acid exposure to the lining of the stomach. This gives the tissue a chance to heal, which will reduce symptoms of gastritis. There are several ways drugs can work to protect the stomach lining from acid. This includes decreasing acid production, coating the stomach lining, and increasing the production of protective substances. These actions can all be effective treatments for gastritis.

PPIs are potent stomach acid inhibitors. They work by blocking cells in the stomach from producing acid. PPIs are available over the counter and by prescription including:

  • Dexlansoprazole (Dexilant)
  • Lansoprazole (Prevacid)
  • Pantoprazole (Protonix)
  • Rabeprazole (Aciphex)

Histamine H2-receptor antagonists reduce the amount of acid the stomach produces. Another name this class is H2 blockers. Like PPIs, these drugs have both prescription and over-the-counter versions. They include:

  • Cimetidine (Tagamet)
  • Famotidine (Pepcid)
  • Nizatidine (Axid)
  • Ranitidine (Zantac)

Other gastroprotective medicines include:

  • Antacids, which neutralize stomach acid right away. They can provide quick relief of gastritis symptoms, but their effects are not as long-lasting as PPIs or H2 blockers. They are conveniently available over the counter and can be effective for mild cases of gastritis. Formulations include aluminum hydroxide, magnesium hydroxide, and calcium carbonate.
  • Misoprostol (Cytotec), which helps your body replace prostaglandins in the stomach. Prostaglandins act to protect the stomach lining. NSAIDs inhibit their formation. So, misoprostol can be useful for treating NSAID-induced gastritis. It is a prescription medicine.
  • Sucralfate (Carafate), which protects the stomach lining from acid by forming a gel barrier. This medicine is also available by prescription.

If you have diarrhea and vomiting, fluid and electrolyte replenishment is also a component of successful treatment. Fluid replenishment helps prevent an electrolyte imbalance and dehydration, which can become life threatening.

How is chronic erosive gastritis diagnosed and treated?

Erosive gastritis is most often an acute gastritis that happens suddenly. It usually shows up as signs of a bleeding episode, such as bloody vomit or stool, within 2 to 5 days of the event that caused it. In some cases, erosive gastritis can be chronic, such as with gastritis from alcohol abuse or addiction.

Erosive gastritis diagnosis

Diagnosing acute and chronic erosive gastritis involves an upper endoscopy (upper GI endoscopy). Your doctor can examine the inside of your esophagus, stomach, and small intestine during an upper endoscopy. If something suspicious shows up, your doctor can take a biopsy—or tissue sample—with tiny tools through the endoscope. A biopsy can show if H. pylori or other abnormalities are present in the stomach lining.

You will have sedation before undergoing endoscopy. This will keep you relaxed and even sleepy during the procedure. You probably will not have much memory of what occurred during the procedure. Depending on what your doctor finds, an upper endoscopy can take about 15 to 30 minutes. You can generally return to normal activities after the sedation wears off. However, you will need someone to drive you home and it is best to take it easy for the rest of the day.

Erosive gastritis treatment

For severe gastritis with bleeding (bloody vomit, black tarry stools, or light-headedness), you will need to be hospitalized to stop the bleeding. This may be possible during upper endoscopy, but surgery may be necessary in some cases. Your doctor will likely start you on a PPI or other medicines that suppress stomach acid production. A blood transfusion may be necessary in case of blood loss.

How do you relieve gastritis pain at home?

Antacids are a quick way to relieve gastritis pain and other symptoms at home. You can get them readily over the counter in pharmacies and other stores.

There are also several lifestyle habits that can help ease your symptoms. Try the following strategies to relieve gastritis pain and symptoms:

  • Change how you eat. Eating smaller, more frequent meals instead of three large meals can prevent indigestion, bloating, and other digestive upset symptoms.
  • Change what you eat. Many people find that certain foods can be irritating to their stomach and trigger symptoms of gastritis. To find your problematic foods, keep a diary. Record the foods you eat at each meal and whether or not you experience symptoms afterwards. Common culprits include fatty, fried, greasy, spicy or acidic foods. Beverages can also cause problems, so include them in your diary to be complete.
  • Change your alcohol consumption. If you have gastritis, it is best to avoid alcohol altogether. Eliminating it can ease the irritation on the stomach lining and allow it to heal.
  • Change your pain reliever. If you use aspirin or NSAIDs for pain, try switching to acetaminophen (Tylenol). It does not cause gastritis and stomach upset. However, it is not useful if you are treating inflammation or swelling. Never take NSAIDs on an empty stomach—consume with food or milk. Talk with your doctor if you need an alternative pain reliever.

If these changes fail to relieve your symptoms, make an appointment with your doctor. It will be helpful to share your food and symptom diary with your doctor. Also, bring a list of all your current medications. Be sure to let your doctor know if you notice symptoms after taking any of your medicines.

What are the potential complications of gastritis?

In most cases, gastritis improves and heals soon after starting treatment. You can help minimize your risk of serious complications by following the treatment plan you and your healthcare provider design specifically for you. Possible complications of gastritis include:

  • Internal hemorrhaging (bleeding)
  • Severe discomfort or pain
  • Spread of infection
  • Stomach ulcers

Contact your doctor right away if your gastritis treatment is not controlling your symptoms.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Aug 12
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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