What Is Gastritis?

Symptoms of gastritis can include upper abdominal pain, and sometimes nausea, vomiting, and/or a feeling of fullness soon after eating. The condition is characterized by inflammation of the stomach lining.

While there are many potential causes of gastritis, infection with a bacteria called Helicobacter pylori is one of the most common ones. Excessive use of nonsteroidal anti-inflammatory medication (NSAIDs) or alcohol are additional common causes of gastritis.

This article discusses the symptoms of gastritis, some of its potential causes, and how the condition is diagnosed and treated.

Gastritis Symptoms

The most common symptom of gastritis is upper abdominal upset or pain. The pain is 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).

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

Types of Gastritis

The symptoms of gastritis can come on suddenly and last for a short time. This is called acute gastritis. Chronic gastritis means symptoms persist for months or even years. Chronic gastritis is much more likely to lead to complications like ulcer formation and iron deficiency anemia from bleeding. Some people with chronic gastritis go on to develop gastric cancer, but this is rare.

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.
  

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 practitioner may run some tests and diagnose you with gastritis, they may also refer you to a gastroenterologist. This is a medical professional who specializes in diseases of the esophagus, stomach, and intestines. This is particularly likely if your diagnosis is not certain, or if your gastritis is severe or persistent.

Your healthcare provider will take a careful medical history and do a physical examination. If gastritis is suspected, your may need blood tests and, potentially, a set of X-rays called an upper gastrointestinal (GI) series. Additional testing, such as an upper endoscopy, may also be needed.

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

Blood Tests

Your healthcare provider will order the following blood tests to check for iron deficiency anemia from potential stomach bleeding:

• Complete blood count (CBC)
• Iron tests, including a ferritin level (ferritin is a protein that stores iron)

Your healthcare provider 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 made by stomach cells.

Sometimes, a person's immune system attacks the stomach cells themselves. This causes impaired vitamin B-12 absorption and 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. A series of X-rays lets a healthcare provider visualize the digestive tract.

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 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:

• Gastroesophageal reflux disease (GERD)
• Peptic ulcer disease (which may also be a complication of gastritis)
• Gastroparesis
• Gallbladder disease
• Inflammatory bowel disease (IBD)
• Pancreatitis
• Gastric cancer (which may also be a complication of gastritis)

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

• Acute coronary syndrome (ACS)
• Pregnancy

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 involves addressing the underlying cause.

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

If a Helicobacter pylori infection is the cause, your healthcare provider 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 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) may be recommended. Sometimes, an antacid is included in your treatment plan for rapid relief.

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 (like smoking, regular NSAID use, and excessive alcohol intake), researchers have looked into whether preventing H.pylori infection is possible. 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 can 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 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, avoid putting your mouth on your child's pacifier or bottle, or tasting their food

Summary

Gastritis is an inflammation of the lining, which causes upper abdominal pain and other possible symptoms like nausea and vomiting. It can have a number of potential causes, including infection with H. pylori, excessive use of NSAIDs, and alcohol use. 

The cause of gastritis can usually be identified with a series of blood tests and/or visual tests like an upper endoscopy. Treatment depends on the underlying cause.

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 healthcare provider as instructed.

Sometimes repeat tests are needed to ensure effective treatment. And if a habit like 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.