Gastritis is an inflammation, irritation, or erosion of the lining of the stomach. It can occur suddenly (acute) or gradually (chronic).
There are two main types of gastritis: acute and chronic.
Acute gastritis: Acute gastritis can cause pain and swelling in the stomach but generally does not last for a long period of time – it stops within a few days.
Chronic gastritis: Chronic gastritis is just that – chronic. This refers to it lasting for a long period of time. Someone may have chronic gastritis and not even realize it because symptoms are dull and not severe.
Epidemiology of gastritis
It is estimated that about 50% of the population is infected with H pylori, which is the main cause for gastritis. Chronic presence of H. Pylori in stomach causes repeated frequent gastritis resulting in chronic gastritis. H pylori infection is rampant in the developing countries including Asia. The mortality statistics of gastritis indicates that most number of cases are reported in United States and Mexico.
Risk factors for gastritis include the following:
- Alcohol use
- Bacterial infection (e.g., Helicobacter pylori)
- Certain medications
- Chemotherapy drugs (used to destroy cancer cells)
- Iron and potassium supplements
- Nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., ibuprofen, naproxen)
- Erosion or thinning of the stomach lining (e.g., due to age)
- High levels of stress
A major cause of both acute and chronic gastritis is infection of the stomach mucosa by a bacterial species named Helicobacter pylori. Usually, this bacterium first infects the stomach antrum (stomach mucosa without acid-producing cells) acutely and may progress to infect most or all of the stomach’s mucosa over time (chronic gastritis) and remain there for years. This infection generates an initial strong inflammatory response and eventually, a long-term chronic inflammation with intestinal cell changes may develop. Another major cause of acute and chronic gastritis is the use (and overuse) of non steroidal anti-inflammatory drugs (NSAIDs).
However, there are many other causes of gastritis; the following is a list of common causes of both acute and chronic gastritis; chronic gastritis may occur with repeated or continual presence of most of these causes:
- Bacterial, viral and parasitic infections
- Certain drugs (cocaine)
- Bile reflux
- Fungal infections
- Allergic reactions
- Stress reaction
- Certain food poisonings (infectious and chemical)
In general, infectious agents, especially Helicobacter pylori, and NSAIDs are responsible for the majority of people with gastritis.
Normal stomach and gastritis
The signs and symptoms of gastritis include:
- Gnawing or burning ache or pain (indigestion) in your upper abdomen that may become either worse or better with eating
- A feeling of fullness in your upper abdomen after eating
- Gastritis doesn’t always cause signs and symptoms.
Diagnosis and test
Gastritis is diagnosed based on the patient’s symptoms and history of a previous diagnosis and treatment of gastritis, alcohol consumption, and use of NSAIDs. Definitive diagnosis of gastritis is made by identifying the underlying cause of the gastric mucosal inflammation and/or by tissue (gastric) biopsy.
For example, the major infective cause of gastritis is Helicobacter pylori (H. pylori). This bacterium can be detected by breath, blood, stool, immunological and biopsy tests. Although the bacterium can be cultured from the patient, this is seldom attempted. Other pathogens can be identified using culture, stool and immunological tests.
Biopsy of the stomach mucosa, done duringendoscopy examinations, is often used in patients to identify the causes of chronic gastritis and may allow visualization of mucosal erosions and other stomach mucosal changes. Abdominal X-rays or barium studies (upper or lower) may demonstrate the presence of thickened mucosa and folds that are signs of inflammation in the stomach.
Treatment and medications
Treatment of gastritis depends on the specific cause. Acute gastritis caused by nonsteroidal anti-inflammatory drugs or alcohol may be relieved by stopping use of those substances.
Medications used to treat gastritis include:
Antibiotic medications to kill H. pylori: For H. pylori in your digestive tract, your doctor may recommend a combination of antibiotics, such as clarithromycin (Biaxin) and amoxicillin (Amoxil, Augmentin, others) or metronidazole (Flagyl), to kill the bacterium.
Medications that block acid production and promote healing: Proton pump inhibitors reduce acid by blocking the action of the parts of cells that produce acid. These drugs include the prescription and over-the-counter medications omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), esomeprazole (Nexium), dexlansoprazole (Dexilant) and pantoprazole (Protonix). Long-term use of proton pump inhibitors, particularly at high doses, may increase your risk of hip, wrist and spine fractures. Ask your doctor whether a calcium supplement may reduce this risk.
Medications to reduce acid production. Acid blockers also called histamine (H-2) blockers reduce the amount of acid released into your digestive tract, which relieves gastritis pain and encourages healing. Available by prescription or over-the-counter, acid blockers include ranitidine (Zantac), famotidine (Pepcid), cimetidine (Tagamet HB) and nizatidine (Axid AR).
Antacids that neutralize stomach acid. Your doctor may include an antacid in your drug regimen. Antacids neutralize existing stomach acid and can provide rapid pain relief. Side effects can include constipation or diarrhoea, depending on the main ingredients.
Complications of untreated chronic gastritis include:
Anemia: erosive gastritis can cause chronic bleeding which, in turn, can lead to anemia
Atrophic gastritis: chronic inflammation in the stomach can cause the loss of both the stomach lining and glands
Peptic ulcers: ulcers can form in the lining of the stomach and duodenum
Growths in the stomach lining: the risk of both benign (noncancerous) and malignant (cancerous) growths increases in people with gastritis. If the gastritis is caused by H. pylori bacteria, it also increases the risk of a specific form of cancer known as gastric mucosa-associated lymphoid tissue (MALT) lymphoma.
- Some cases of gastritis are caused by viral infection. This means that a person may protect his or her own health by preventing contact with Helicobacter pylori.
- Another important restriction to make, in order to prevent gastritis, is to stop using aspirin, ibuprofen, naproxen and any other medications that can irritate the stomach lining and cause inflammation.
- People should also drink alcohol only in moderation. This means up to one drink a day for women and two drinks a day for men.
- It is also important to avoid taking acid and carbonated beverages, coffee and juices with citric acid. One should also avoid smoking.