A Guide to Gastritis

Gastritis is inflammation and irritation of the stomach lining or mucosa. This can result in abdominal pain, loss of appetite, and possibly bleeding. Causes include Helicobacter pylori (H. pylori) infection and use of alcohol, tobacco, and nonsteroidal anti-inflammatory drugs (NSAIDs).

Gastritis treatment depends on the cause. For H. pylori-related gastritis, antibiotics in addition to an acid-blocking drug is standard care. For other types of gastritis, treatment includes proton pump inhibitors (PPIs), H2 blockers, and antacids.

This article explains gastritis and its symptoms, causes, and treatments.

Typically, the stomach lining has a protective layer. This mucosal covering shields it from the effects of stomach acid. The irritation and inflammation of gastritis reduce this protection. The stomach lining is vulnerable to the acidity inside the stomach. 

Causes of gastritis include alcohol consumption, tobacco use, and prolonged use of aspirin and NSAIDs. The most common cause of gastritis is a stomach infection with H. pylori. 

H. pylori is a type of bacteria found in up to half of all people worldwide. In the United States, about 35% of the population has an infection of this bacteria.

Gastritis can be acute, coming and going quickly. It can also be chronic, lasting months or even years. Acute gastritis is the most common form in the U.S. About 8 in 1,000 Americans will get acute gastritis. Chronic gastritis is less common, affecting about 1 in 10,000 Americans.

Doctors can classify gastritis in a few ways: by severity, location, or inflammatory cell type.

All types of gastritis fall into one of the following categories based on the extent of injury to the stomach lining:

• Erosive gastritis: This means the inflammation wears away the stomach lining. Eventually, this can cause lesions or ulcers. It is usually an acute gastritis and is more serious than the nonerosive form. Gastrointestinal (GI) bleeding is more common with erosive gastritis. In some cases, erosive gastritis can be chronic, such as with gastritis from alcohol use disorder.
• Nonerosive gastritis: This means the stomach lining does not wear away. Instead, the lining 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. Nonerosive gastritis is usually a form of chronic gastritis and is often asymptomatic.

Gastritis causes a number of symptoms. The symptoms can vary in intensity from person to person. Symptoms can also be constant or come and go. With nonerosive gastritis, symptoms can be vague.

Most people with gastritis do not have any symptoms.

Common symptoms of gastritis include:

• bloating, a sense of feeling too full, or feeling full too soon
• indigestion
• loss of appetite and unintended weight loss
• nausea with or without vomiting
• upper abdominal burning or gnawing pain, discomfort, or achiness

Gastritis can lead to mild bleeding and anemia. Symptoms of anemia include fatigue, dizziness, pale skin, shortness of breath with activity, and cold hands and feet.

Contact your doctor if you have symptoms of gastritis or anemia that persist. Stomach pain, discomfort, or upset may indicate a potentially serious condition if it lasts for more than a week.

In some cases, gastritis can lead to serious bleeding. This is potentially life threatening. Seek immediate medical care (call 911) for any of these serious symptoms:

• bloody or black vomit that resembles coffee grounds
• bloody or black stool that is tarry in texture
• severe abdominal pain
• shortness of breath or light-headedness

There are several types of gastritis with different causes.

Acute stress gastritis is a form of erosive gastritis. It occurs with a sudden illness or injury that does not have to involve the stomach itself. It affects about 5% of critically ill patients. The longer the stay in the intensive care unit (ICU), the higher the risk of developing acute stress gastritis.

According to a 2012 study, being intubated on a breathing machine for more than 48 hours may also increase your risk for gastritis.

Autoimmune gastritis happens when the body’s immune system mistakenly starts attacking healthy cells in the stomach lining.

Erosive gastritis has several causes. The most common causes include irritation from alcohol, aspirin, NSAIDs, stress, and H. pylori.

H. pylori infection is the most common cause of chronic nonerosive gastritis. It is an extremely common infection. Not everyone with an H. pylori infection develops gastritis or other problems, such as stomach ulcers. It is possible that certain people are more prone to stomach disease from the infection due to genetics or lifestyle factors. 

Other gastritis causes include:

• bile acid reflux
• celiac disease
• chemotherapy and radiation therapy
• chronic vomiting
• eosinophilia
• food allergies
• inflammatory diseases, such as Crohn’s disease and sarcoidosis
• injury from procedures, such as placing a nasogastric tube
• stomach surgery

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

Risk factors for gastritis include:

• Excessive alcohol consumption: Alcohol is irritating to the stomach lining, which can increase the risk for 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: These drugs increase the risk of both acute and chronic gastritis by inhibiting a substance that protects the stomach lining. Examples include ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin.
• H. pylori bacterial infection: The incidence of this infection increases with age. In the U.S., about 10–15% of children age 12 and under have H. pylori infection. Up to 60% of adults older than 60 years have it. The risk is higher for 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 the risk of infection with H. pylori and developing gastritis from it.

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. 

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

• controlling autoimmune diseases with effective treatments
• limiting alcoholic beverages, avoiding drinking on an empty stomach, and seeking help for alcohol use disorder
• stopping smoking or tobacco use
• using NSAIDs and aspirin short-term and taking them with food or milk 

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, find out if you should also be taking an acid-blocking drug.

To diagnose gastritis, your doctor may order testing, including: 

• H. pylori detection tests: These tests may involve a breath test, blood test, or stool test. 
• Upper endoscopy: This test involves passing an endoscope down your throat to examine your esophagus, stomach, and small intestine.
• Upper GI series, or a barium swallow: This test involves drinking barium and taking X-rays of your upper digestive tract. It is less commonly used.

Gastritis treatment will depend on the underlying cause. If a drug or substance is causing gastritis, symptoms may resolve by discontinuing it.

In some cases, there is no clear cause of gastritis. For unexplained gastritis, seeking a second opinion may help.

For gastritis due to H. pylori infection, triple therapy is the mainstay of treatment. This involves two or more antibiotics for 14 days, in addition to a PPI. 

Antibiotics for H. pylori treatment include:

• amoxicillin (Amoxil, Trimox, others)
• clarithromycin (Biaxin)
• metronidazole (Flagyl)
• tetracycline (Achromycin V, Sumycin)

Medications that reduce stomach acid can help treat gastritis. Reducing stomach acid gives the tissue a chance to heal. 

PPIs are potent stomach acid inhibitors. They work by blocking cells in the stomach from producing acid. PPIs include:

• dexlansoprazole (Dexilant)
• esomeprazole (Nexium)
• lansoprazole (Prevacid)
• omeprazole (Prilosec)
• pantoprazole (Protonix)
• rabeprazole (Aciphex)

Histamine H2-receptor antagonists reduce the amount of acid the stomach produces. Another name for this class is H2 blockers. They include:

• cimetidine (Tagamet)
• famotidine (Pepcid)
• nizatidine (Axid)

Antacids neutralize stomach acid right away, and as such, can provide quick relief of gastritis symptoms. However, the effects of antacids are not as long lasting as PPIs or H2 blockers. 

For severe gastritis with bleeding, hospital treatment may be necessary to stop the bleeding. This may be possible with endoscopy, but it may require surgery in some cases. A blood transfusion may also be necessary.

Several lifestyle habits can help ease gastritis symptoms, including the following strategies:

• Change how you eat: Eat smaller, more frequent meals instead of three large ones.
• Change what you eat: Many people find that certain foods can irritate their stomach and trigger symptoms of gastritis.
• Change your alcohol consumption: If you have gastritis, it is best to avoid alcohol altogether to allow the condition to resolve.
• Change your pain reliever: If you use aspirin or NSAIDs for pain, try switching to acetaminophen (Tylenol). Talk with your doctor if you need an alternative pain reliever.
• Keep a symptom-based food journal: Note the foods you eat and beverages you drink. Record any symptoms you experience, their severity, or if you experience no symptoms.

If these changes fail to relieve your symptoms, make an appointment with your doctor. 

In most cases, gastritis improves and heals soon after starting treatment. Possible complications of gastritis include:

• bleeding
• perforated gastric ulcer, which can lead to bleeding
• stomach cancer
• stomach ulcers

The irritation and inflammation of gastritis can cause stomach upset and other symptoms. However, most people do not know they have this condition.

The most common cause is an H. pylori infection, which is usually asymptomatic. If your doctor diagnoses this infection, the standard treatment consists of two antibiotics and a PPI. In most cases, gastritis resolves with this triple therapy approach.