Atrophic Gastritis: Definition, Causes, Prevention

Atrophic gastritis is a condition that affects nearly 8% of the population. It is a form of chronic gastritis that changes the cells in the stomach lining, where stomach acid is made. It can cause several symptoms, such as stomach pain and tiredness, but it may also present without any symptoms.

Atrophic gastritis usually is caused by a bacterial infection or an autoimmune response. Treatment is focused on managing the underlying condition. This article will cover atrophic gastritis causes, symptoms, and treatment. It will also discuss prevention and risk factors.

Definition of Atrophic Gastritis

Gastritis is the inflammation of the stomach lining. Atrophic gastritis is a form of chronic gastritis that also has the following features:

• Chronic inflammation
• Mucosal thinning (atrophy)
• Stomach cell changes
• Loss of certain cells in the gastric glands

It is often caused by either a Helicobacter pylori (H. pylori) bacterial infection or an autoimmune response. Atrophic gastritis has also been linked to an increased risk of stomach cancer.

Location

Atrophic gastritis affects the lining of the stomach, medically known as the gastric mucosa. This layer of the stomach contains the cells that make stomach acid and protects the stomach against irritation.

Bacterial Infection vs. Autoimmune

There are two common causes of atrophic gastritis: a bacterial infection and an autoimmune response.

Bacterial infection by H. pylori is the most common cause. An H. pylori infection is common, affecting about two-thirds of the population. This bacterium can cause other stomach conditions as well, such as peptic ulcers, stomach cancer, and mucosa-associated lymphoid tissue lymphoma (MALT).

H. pylori is spread through contact with infected saliva, stool, or vomit. It can also be spread through contaminated water and food.

Autoimmune atrophic gastritis occurs when the body attacks the healthy cells in the stomach lining. This leads to decreased stomach acid production and the loss of intrinsic factor, a protein that helps the body absorb vitamin B12.

Those with autoimmune atrophic gastritis can have significant vitamin B12 deficiency anemia, which is called pernicious anemia.

How Does Stomach Inflammation Happen?

Stomach inflammation refers to the swelling and irritation of the lining of the stomach. It can happen from an H. pylori infection, autoimmune response, bile reflux, or lifestyle factors. Lifestyle factors can include:

• Eating spicy foods
• Consuming too much alcohol
• Caffeine
• Smoking
• Stress
• Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs)

When the stomach is exposed to these factors or infectious germs it can respond by becoming irritated and swollen.

Risk Factors

One of the main risk factors for atrophic gastritis is an H. pylori infection. According to the Centers for Disease Control and Prevention (CDC), certain populations have a higher likelihood of acquiring H. pylori. These populations include:

• Older adults
• Hispanics
• African Americans
• People of lower socioeconomic groups

Autoimmune atrophic gastritis was formerly thought to be a disease mainly affecting older women of northern European ancestry. However, it has been found in people of all ages, ethnicities, and genders.

Prevention

There is no perfect way to prevent gastritis. However, there are ways to reduce your risk of developing the condition, including:

• Practice good hand hygiene to prevent an H. pylori infection.
• Avoid eating and drinking things that irritate the stomach.
• Avoid taking NSAIDs.

Symptoms

People with atrophic gastritis may not have symptoms until late into their disease. This makes it difficult to diagnose and treat promptly.

Atrophic gastritis caused by an H. pylori infection has different symptoms than autoimmune atrophic gastritis.

When atrophic gastritis is caused by an H. pylori infection, it can cause the following symptoms:

• Stomach pain
• Nausea and vomiting
• Headaches
• Loss of appetite

Autoimmune atrophic gastritis symptoms are generally a result of the vitamin B12 deficiency called pernicious anemia. These symptoms can include:

• Fatigue
• Dizziness
• Insomnia
• Depression
• Irritability
• Fast heart rate
• Neuropathy (nerve pain)
  

Diagnostic Testing

Diagnosis for atrophic gastritis starts with a health history review and physical exam by a healthcare provider. Based on their findings, additional testing may be ordered.

Blood tests may be used to look at gastric function, but the gold standard diagnostic test is an upper endoscopy, also known as an esophagogastroduodenoscopy (EGD).

An EGD is a small scope inserted into the mouth, advanced through the esophagus, and passed into the stomach. With a small camera on the end, it can take images of the stomach and also remove tissue for biopsies. An EGD can confirm the gastritis diagnosis.

If a healthcare provider suspects an H. pylori infection, they may order a blood, stool, or breath test to diagnose the infection.

Treatment

Atrophic gastritis treatment is focused on managing the underlying cause of the condition.

Since the majority of people with atrophic gastritis have an H. pylori infection, it is important to treat and eliminate that bacterium. H. pylori treatment involves taking a proton pump inhibitor (PPI) and two antibiotics for the prescribed length of time.

If the patient has vitamin B12 deficiency, supplements, or intravenous (IV) infusions may be used to restore their levels.

An affected gastric mucosa can return to normal in some people who successfully have their H. pylori infection treated.

Cancer Link

Atrophic gastritis is considered a precursor to stomach cancer. However, most people who have atrophic gastritis will not get stomach cancer.

A 2017 study showed less than 2% of people with atrophic gastritis got stomach cancer.

While there is a link between atrophic gastritis and cancer, it is not guaranteed. It's important to look at other risk factors, like alcohol consumption and age, which may play a factor in the development of stomach cancer.

Management After Initial Treatment

Immediate management of atrophic gastritis involves antibiotics (as appropriate) and PPI medications. The American Gastroenterological Association (AGA) recommends a routine EGD to look for stomach cancer and other stomach changes. The AGA recommends performing an EGD every three years in people with advanced atrophic gastritis.

Summary

Atrophic gastritis is a form of chronic gastritis. It is commonly caused by either an H. pylori bacterial infection or an autoimmune response. Treatment is focused on eliminating the bacterial infection and correcting any nutritional deficiencies. Atrophic gastritis is a precursor to stomach cancer. As a result, someone with atrophic gastritis will need follow-up healthcare provider appointments to screen for cancer.