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Gastritis

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What is gastritis?

Gastritis describes a group of conditions characterized by inflammation of the stomach lining. Almost everyone will experience gastritis at some point, but it is not usually dangerous and generally improves with treatment. It can occur suddenly, or it may develop slowly over time.

Symptoms of gastritis include reduced hunger, stomach-ache or nausea and vomiting. In some cases, it can also lead to ulcers, bleeding in the stomach or an increased risk of stomach cancer. Quite often though, gastritis produces no noticeable symptoms.

An inflammation of the stomach lining as a result of gastritis. 

Causes

The stomach lining is a wrinkled layer within the stomach that releases mucus and other substances that help to break down food. This mucus creates a protective barrier between the stomach wall and acids inside the stomach. Gastritis occurs when a hole in the mucus barrier develops, allowing highly acidic digestive juices to pass through and damage the stomach wall. The end result is inflammation that may occur suddenly, or gradually over time.

The formation of an ulcer due to inflammation caused by gastritis. 

This process can be triggered by a number of different factors, including:

Helicobacter pylori infection

Gastritis is often caused by a bacteria called Helicobacter pylori, or H. pylori for short. More than 30% of the world's population is infected with H. pylori, making it one of the most common bacterial infections. These bacteria live deep in the mucus that coats the stomach lining.

Although long-term infection is known to cause gastritis in some people, it is also possible for others to carry H. pylori without ever developing symptoms. For this reason, other factors are also thought to play a role in making certain people more sensitive to H. pylori-related gastritis.

Medications

A class of medications, known as non-steroidal anti-inflammatory drugs (NSAIDs), may cause gastritis when taken regularly. Common NSAIDs include aspirin, ibuprofen and naproxen. These medications decrease the levels of certain prostaglandins in the body, which help to protect the stomach lining from stomach acid.

Other medications and drugs that can cause gastritis include corticosteroids, cocaine, alcohol and chemotherapy medications.

Autoimmune response

In rare cases, a condition called autoimmune gastritis may develop, usually in older adults. The term 'autoimmune' describes a situation in which the body's own immune system mistakenly attacks healthy cells, as if fighting an infection or healing a wound. In autoimmune gastritis, this attack causes inflammation and damage to the stomach lining, which may prevent the body from absorbing nutrients, such as vitamin B12. A lack of vitamin B12 can lead to a serious condition, called pernicious anemia.

Underlying medical condition

Gastritis can be caused by a medical condition called bile reflux. Bile is a fluid produced by the liver to remove toxic substances, break down fat and help with digestion. Usually, bile is stored in the gall bladder and is released into the small intestine after eating. Bile reflux occurs when bile flows back up through the small intestine and leaks into the stomach.

Other conditions that can cause gastritis include severe stress, major surgery or trauma, infection with a virus, fungus or parasite, Crohn's disease, HIV/AIDS and kidney disease.

Risk factors

Risk factors that increase the likelihood of developing gastritis include:

  • Age - older adults are more likely to develop gastritis as they have thinner stomach linings and a higher chance of H. pylori infection;
  • Regular use of alcohol and certain medications, such as NSAIDs and corticosteroids, and;
  • High stress from daily life or a traumatic event.

Types

There are four types of gastritis:

Signs and symptoms

In many cases, gastritis does not produce any symptoms. When present though, symptoms may include:

Less commonly, the stomach lining can wear away over time, leading to stomach ulcers and bleeding. When this occurs, symptoms may also include very dark stools, or blood in the stool or vomit.

Methods for diagnosis

Your doctor will usually suspect gastritis based upon your symptoms. Tests are usually performed to help find the underlying cause. These include:

H. pylori testing

A blood or stool test may be requested to help identify H. pylori bacteria. Sometimes a breath test may also be used to check for H. pylori bacteria.

Upper endoscopy

If further testing is required, your doctor may refer you to have an upper endoscopy (gastroscopy). During an upper endoscopy, you will be sedated and a long, narrow telescopic camera will be inserted into your throat to view the upper digestive system, including the lining of the stomach. Tissue samples (biopsy) can be obtained from the lining of the stomach, especially if there are any suspicious lesions.

An endoscopy procedure. 

Tissue biopsy

Analysis of a biopsy taken during an upper endoscopy, under a microscope by the pathologist, can help confirm gastritis. It can also help to assess the severity of gastritis and identify the underlying cause, such as the presence of H. pylori bacteria or autoimmune gastritis.

Types of treatment

The main treatments for gastritis are aimed at avoiding substances that trigger inflammation, reducing the amount of acid in the stomach and fighting H. pylori infection (if present). Your doctor may recommend one or more of the following options:

Self care

Your doctor may recommend lifestyle changes to improve your overall digestive health. For example, changes to your eating habits could include limiting portion sizes, keeping regular meal times and eating a balanced diet, free of foods that cause irritation. Cutting down smoking and alcohol, and avoiding NSAIDs use may also improve symptoms. It is also recommended to limit caffeinated drinks, such as coffee, tea and soft drinks, which can increase stomach acid secretion.

Similarly, moderate exercise has been shown to improve digestion by encouraging faster movement of food through the digestive system. As stress can cause increased production of stomach acid and slow digestion, relaxing activities such as yoga, tai chi or massage may also be recommended.

Medications

Antacids

For mild cases of gastritis, over-the-counter antacid tablets may be suggested to balance the level of acid in the stomach. Common antacids include aluminum hydroxide, magnesium carbonate and magnesium triscilicate. Antacids may also contain an ingredient, called simeticone, to help reduce wind.

Histamine blockers

If antacids are not effective, your doctor may prescribe a stronger family of medications, known as histamine 2 (H2) blockers. These medications reduce the amount of acid in the stomach by blocking a natural chemical in the body, called histamine. Some examples of H2 blockers for gastritis include ranitidine, cimetidine, and famotidine.

Proton pump inhibitors

Proton pump inhibitors (PPIs) are a family of medications that also reduce the amount of stomach acid, but in a different way. The main PPIs prescribed for gastritis are esomeprazole, pantoprazole and omeprazole tablets.

Antibiotics

In cases of gastritis caused by H. pylori, your doctor will most likely prescribe antibiotics to kill the bacteria. Most commonly, the antibiotics amoxicillin and clarithromycin are prescribed together with esomeprazole or omeprazole. This combination treatment is referred to as PPI-based triple therapy.

If triple therapy does not clear the infection, your doctor may try a different combination or dosage of medications. Side effects of treatments for H. pylori infection may include nausea, heartburn, headache and diarrhea.

Potential complications

If left untreated, gastritis can lead to stomach ulcers (known as peptic ulcer disease). In cases of long-term H. pylori infection or autoimmune gastritis, a condition called atrophic gastritis can occur.

Atrophic gastritis

Atrophic gastritis involves destruction of the cells in the stomach lining that produce the digestive juices. These changes to the stomach lining are linked to an increased risk of stomach cancers.

Duodenitis

Gastritis can also spread to involve the first part of the small intestine (duodenum), known as duodenitis. It is managed in the same way as gastritis.

Peptic ulcer disease

Peptic ulcer disease, also known as stomach ulcers, occurs when the lining of the stomach or duodenum erodes away, exposing the underlying delicate tissues, which are highly sensitive to damage from stomach acid. It is a long-term complication of gastritis and duodenitis.

Without treatment, peptic ulcer disease can lead to bleeding from the stomach, which can be severe and life-threatening. Occasionally, the ulcer can progress through the entire stomach or duodenal wall, causing a perforation. This can allow stomach contents and acid to contaminate the abdominal cavity, which is a serious medical condition that needs immediate treatment.

Prognosis

Gastritis usually is not serious and improves quickly with lifestyle changes and medications. In fact, it is quite common for mild gastritis to pass without treatment or a visit to the doctor.

However, if your gastritis is caused by H. pylori infection, your doctor will most likely schedule a follow-up appointment after treatment has finished to check that the infection has cleared. This is because long-term infection can lead to ulcers, in some cases.

Prevention

Methods for preventing gastritis closely mirror the self-care treatment options. For example, modifying your lifestyle to include healthy eating, moderate exercise and activities to reduce stress may be recommended by your doctor. Similarly, cutting down your intake of alcohol and NSAIDs may also help to prevent irritation of the stomach lining.

At present, it is unknown exactly how H. pylori bacteria is spread. However, it is thought to be passed from person to person through crowded living conditions and poor sanitation. For this reason, the risk of developing gastritis may be reduced through good hygiene measures.

References

  1. Royal Australian College of General Practitioners (RACGP). [Online]. Available from: link here [Accessed 15th May 2014].

10 Most frequently asked questions (FAQs)

What is gastritis?
Gastritis refers to inflammation of the stomach lining. Almost everyone will experience gastritis at some point, but it usually is not dangerous and improves with treatment. Gastritis is usually treated with lifestyle changes and medication.
What are the symptoms of gastritis?
In many cases, gastritis does not produce any symptoms. When present though, symptoms may include reduced hunger, weight loss, stomach ache, hiccups, heartburn, and nausea and vomiting. Less commonly, the stomach lining can wear away over time, leading to ulcers and bleeding. When this occurs, symptoms may also include very dark stools, or blood in the stool or vomit.
What causes gastritis?
The stomach lining is a wrinkled layer within the stomach that releases mucus and other substances that help to break down food. This mucus creates a protective barrier between the stomach wall and stomach acids. Gastritis occurs when a hole in the mucus barrier develops, allowing highly acidic digestive juices to pass through and damage the stomach wall. This results in inflammation that may occur suddenly or gradually over time. This process can be triggered by several different factors, including overuse of certain pain-relief medications, substance abuse, an underlying medical condition, or infection with Helicobacter pylori bacteria.
What sort of medications can cause gastritis?
A class of medications, known as non-steroidal anti-inflammatory drugs (NSAIDs), may cause gastritis when taken regularly or over a long period of time. Common NSAIDs include aspirin, ibuprofen and naproxen. These medications decrease the levels of prostaglandin, a natural chemical in the body that helps to protect the stomach lining from damage. Other medications and drugs that can cause gastritis include corticosteroids, cocaine, alcohol and chemotherapy medications.
How is gastritis diagnosed?
Your doctor will usually suspect gastritis based upon your symptoms. A blood, stool or breath test may be conducted to test for Helicobacter pylori bacteria. An upper endoscopy (gastroscopy) and tissue biopsies can help to assess the severity and identify the underlying cause of your gastritis.
Who gets gastritis?
Almost everyone will experience gastritis at some point. However, it is more likely to develop in older adults, as they have thinner stomach linings and a higher chance of infection with Helicobacter pylori bacteria. People with high levels of stress or who regularly consume drugs and alcohol are also more likely to develop gastritis.
Are there different types of gastritis?
Gastritis that occurs suddenly is sometimes referred to as acute gastritis. However, when the condition develops slowly and lasts for a long time, it is known as chronic gastritis. Sometimes gastritis can also wear away the stomach lining over time, which leads to bleeding, thinning of the stomach lining, or ulcers of the stomach or small intestine. In these cases, the condition may be referred to as erosive gastritis. If the inflammation of the stomach lining is caused by an autoimmune response, the condition is known as autoimmune gastritis.
How is gastritis treated?
Sometimes, no specific treatment will be necessary for your gastritis. However, if required, the main treatments are: avoiding substances that trigger inflammation; reducing the amount of acid in the stomach, and; fighting Helicobacter pylori bacterial infection. Therefore, treatment usually involves lifestyle changes and one or more medications. The type of medication will depend on the cause of gastritis and how serious the symptoms are.
What is the connection between Helicobacter pylori bacteria and gastritis?
Gastritis is often caused by Helicobacter pylori bacteria, or H. pylori for short. More than 30% of the world's population is infected with H. pylori, making it one of the most common bacterial infections. These bacteria live deep in the mucus that coats the stomach lining. However, although long-term infection is known to cause gastritis in some people, it is also possible for others to carry H. pylori without ever developing symptoms. For this reason, other factors are also thought to play a role in making certain people more sensitive to developing H. pylori-related gastritis.
Does gastritis cause cancer?
In cases of long-term Helicobacter pylori infection or autoimmune gastritis, a condition called atrophic gastritis can occur. Atrophic gastritis destroys the cells in the stomach lining that produce the digestive juices. These changes to the stomach lining are linked to an increased risk of stomach cancer. If left untreated, gastritis can also lead to ulcers in the stomach or small intestine, or bleeding from the stomach.

Related topics

Barrett’s esophagus

Barrett's oesophagus occurs when the cells lining the oesophagus – the tube that connects the mouth and the stomach – change from a type of cell called squamous into columnar (cells more typical of the stomach and small intestine), due to damage from acid reflux.

Heartburn

Heartburn, also known as GORD (gastro-oesophageal reflux disease) or acid reflux, occurs when stomach acid or contents travel from the stomach back up the oesophagus, usually into the mouth. There are numerous treatments to help alleviate symptoms.

Bowel obstruction

Bowel obstruction occurs when you have a complete or partial blockage of your bowel, stopping liquids, solids and gas passing through your small or large intestine. This can cause severe abdominal pain, bloating, nausea and vomiting. Bowel obstruction requires prompt medical assessment.

Chest pain

Chest pain has many causes, ranging from muscle strain to more serious cardiovascular problems such as heart attack. If you do experience chest pain, it is important to seek prompt medical attention.

About this article

Title: Gastritis

Author: Lauren Donley BSc (Hons)

First Published: 23 Sep 2014

Last reviewed: 17 Jan 2022

Category: Information on Gastritis

Average rating: 4.4 out of 5 (1554 votes)

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