What Is Gastritis?

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Gastritis is an often distressing and uncomfortable condition involving inflammation of the stomach lining. Symptoms can include upper abdominal pain, and sometimes, nausea, vomiting, and/or a feeling of fullness soon after eating. While there are many potential causes of gastritis, infection with a bacteria called Helicobacter pylori is one of the most common ones. Excessive nonsteroidal anti-inflammatory (NSAID) or alcohol use are additional common causes of gastritis.

what is gastritis
 Verywell / Gary Ferster

Types of Gastritis

The symptoms of gastritis can come on suddenly and last for a short time. This is called acute gastritis. Others have chronic gastritis, which means symptoms persist for months or even years.

Gastritis can also be categorized as erosive or non-erosive based on how severely injured the mucosal lining of the stomach is.

  • Erosive gastritis is more severe than non-erosive gastritis, as it wears away the stomach lining, leading to the formation of sores called erosions. If left untreated, these sores can penetrate deeper into the stomach mucosa and form painful ulcers.
  • With non-erosive gastritis, the stomach lining is changed as a result of the underlying inflammation; however, there is no wearing away of the lining, so no erosions or ulcers develop.

Gastritis Symptoms

The most common symptom of gastritis is upper abdominal upset or pain, often described as an uncomfortable burning or gnawing sensation.

Besides pain, other potential symptoms of gastritis include:

  • Belching
  • Abdominal bloating
  • Loss of appetite
  • Nausea or vomiting
  • Feeling of fullness after eating only a small meal

Blood in your vomit or dark or tar-colored stools may be a sign of bleeding in the stomach, as gastritis can promote ulcers (sores within the lining of the stomach) to form.

Additional signs and symptoms of bleeding in the stomach (all of which stem from related iron deficiency anemia) include:

  • Fatigue
  • Trouble breathing
  • Dizziness
  • Weakness
  • Pale skin
  • Fast heartbeat

If you are experiencing any signs or symptoms of bleeding in your stomach, it is important to seek immediate medical attention. Severe or worsening abdominal pain is another indication to seek attention right away.

Chronic gastritis is much more likely to lead to complications like ulcer formation and iron deficiency anemia from bleeding. Rarely, some people with chronic gastritis go on to develop gastric cancer.

Causes

There are multiple possible causes of gastritis. One of the most common causes is an infection with the bacterium Helicobacter pylori (H. pylori), which can result from poor handwashing habits and other causes.

Other potential causes include:

  • Drinking too much alcohol
  • Smoking
  • Prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Infection with another bacteria, a virus, or fungus

In addition, gastritis may develop after major surgery, traumatic injury, burns, radiation, or a severe illness. Certain diseases, such as pernicious anemia (an autoimmune disease) and chronic bile reflux, can also cause gastritis.

Sometimes, the precise cause of a person's gastritis remains unknown.

Diagnosis

While your primary care doctor may run some tests and diagnose you with gastritis, they may also refer you to a gastroenterologist—a doctor who specializes in diseases of the esophagus, stomach, and intestines—for further evaluation. This is particularly likely if your diagnosis is not certain, or if your gastritis is severe or persistent.

If gastritis is suspected after a careful medical history and physical examination, blood tests and, potentially, a set of X-rays called an upper gastrointestinal (GI) series are likely next. Additional testing, such as an upper endoscopy, may be needed thereafter.

For persistent symptoms of gastritis, upper endoscopy has now replaced the upper GI series as the primary diagnostic test.

Blood Tests

In order to evaluate for iron deficiency anemia from potential stomach bleeding, your doctor will order the following blood tests:

Your doctor may also check your vitamin B12 level to help diagnose pernicious anemia. With this condition, the immune system misguidedly attacks a vitamin B-12 binding protein (intrinsic factor) made by stomach cells. Sometimes, a person's immune system attacks the stomach cells themselves.

As a result of this attack, vitamin B-12 absorption is impaired, causing low blood levels. Another blood test used to diagnose pernicious anemia is autoantibodies to intrinsic factor (IF).

Lastly, a blood antibody test may be used to evaluate for H.pylori infection, although other tests (see below) are more sensitive and specific.

Upper GI Series

For this, you first drink barium, a chalky white substance mixed with water. The barium coats your esophagus, stomach, and the first part of the small intestines so a doctor can visualize the digestive tract when performing the series of X-rays that follow.

Various gastritis-related abnormalities can be seen with an upper gastrointestinal series, including ulcers and inflammation.

Upper Endoscopy

If the diagnosis of gastritis remains unclear, and/or if your symptoms are severe or persistent, an upper endoscopy may be performed.

During an upper endoscopy, a gastroenterologist eases an endoscope, a thin tube containing a tiny camera, through your mouth (or occasionally nose) and into your stomach. With the camera, they will check for inflammation and may remove a tiny sample of tissue for testing. This is called a stomach biopsy.

Other Tests

Besides these, other tests may be performed to support or confirm a diagnosis of gastritis:

  • A breath test may be recommended to test for H.pylori. With this test you drink a special liquid and your exhaled breath is then examined to see if breakdown products of the bacterium are present in the stomach.
  • A stool antigen test may also be recommended to test for Helicobacter pylori. With this test, a scientist will look for an antigen that is normally located on the surface of the bacteria.
  • A fecal occult blood test looks for blood in a stool sample; a positive test (meaning blood is present) suggests that there is some sort of bleeding within the digestive tract.

Differential Diagnoses

Many other health conditions can cause symptoms similar to those found with gastritis, including:

In addition, non-gastrointestinal conditions can be mistaken for acute gastritis, such as:

Acute coronary syndrome, such as unstable angina or an acute myocardial infarction (heart attack), is a gastritis-mimicker that requires emergent diagnosis and treatment. An electrocardiogram (ECG) and cardiac enzymes (a blood test) are required to distinguish perceived stomach pain from heart-related pain.

This is why a comprehensive evaluation with all of the above tests is often needed to confirm your diagnosis.

Treatment

Treatment of gastritis first entails addressing the underlying cause.

For example, if alcohol or NSAIDs are the culprits behind your gastritis, then stopping them is essential.

If a Helicobacter pylori infection is the cause, your doctor will prescribe you a two-week medication regimen that usually consists of two antibiotics and a proton pump inhibitor (PPI).

Stomach acid irritates the inflamed tissue in the stomach. PPIs such as Prilosec (omeprazole) and Nexium (esomeprazole) work by reducing stomach acid, thereby easing gastritis symptoms and promoting tissue healing.

Once the underlying gastritis culprit disappears, your pain and other symptoms should subside. Of course, be sure to see your doctor before stopping any medicine or starting any gastritis treatment on your own.

Once identifying and eliminating the underlying cause (if known), an acid-reducing medication may be recommended.

Besides a proton pump inhibitor, a histamine blocker, like Pepcid (famotidine) or Zantac (ranitidine), may be recommended. Sometimes, an antacid is included in your treatment plan for rapid relief.

April 1, 2020 Update: The Food and Drug Administration (FDA) announced the recall of all medications containing the ingredient ranitidine, known by the brand name Zantac. The FDA also advised against taking OTC forms of ranitidine, and for patients taking prescription ranitidine to speak with their healthcare provider about other treatment options before stopping medication. For more information, visit the FDA site.

Keep in mind, these acid-reducing medications are generally only recommended for a short period of time. This is especially true for the proton pump inhibitors, as they have been linked to adverse health effects with long-term use.

Prevention

Besides avoiding or minimizing the potential causes of gastritis (e.g., smoking, regular NSAID use, and excessive alcohol intake), researchers have looked into whether preventing H.pylori infection is possible, considering how often this bacterium is the cause of gastritis. According to a study published in 2014, improvements in hygiene reduced rates of infection in children.

Since infection with Helicobacter pylori is often acquired during early childhood and often spread from person to person through the fecal-oral or oral-oral route, teaching parents and their children to practice good hygiene habits may help prevent future gastritis.

Besides washing your (and your child's) hands regularly with soap and water, other hygiene habits include:

  • Ensuring your water comes from a safe, clean source
  • Eating food that is properly washed and cooked
  • Not sharing utensils, toothbrushes, glasses, or cups
  • For mothers of infants, avoiding putting your mouth on your child's pacifier or bottle, or tasting their food

A Word From Verywell

Gastritis is an unpleasant health condition, albeit one that is short-lived and easily treated in many cases. If you are diagnosed with gastritis, be sure to follow up with your doctor as instructed. Sometimes repeat tests are needed to ensure effective treatment. And if it's deemed that a modifiable habit (such as alcohol use) contributed to your case, remember that it's best to continue any changes that improve your gastritis so you can keep the condition at bay.

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Article Sources
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