What Is Gastritis?
Gastritis is a group of diseases that cause inflammation of the lining of the stomach. Acute gastritis occurs suddenly, and will frequently respond to appropriate therapy while chronic gastritis develops slowly. The inflammation of the stomach lining is most frequently caused by a bacterium called H. pylori. Gastritis can vary greatly from mild gastritis to severe gastritis. Symptoms might not always be correlated with the severity of the disease.
What Are the Signs and Symptoms of Gastritis?
Symptoms of gastritis do not always correspond to the extent of physical changes in the lining of the stomach.
- The stomach lining can be examined with an endoscope, a thin probe with a tiny camera at the end that can be inserted through the mouth into the stomach.
- Severe gastritis may be present when the stomach is viewed without any symptoms being present.
- Conversely, severe gastritis symptoms may be present despite only minor changes in the stomach lining.
- Elderly people in particular have a much higher likelihood of developing painless stomach damage. They may have no symptoms at all (no nausea, vomiting, pain) until they are suddenly taken ill with bleeding.
In people who have gastritis symptoms, pain or discomfort in the upper abdomen are the most common symptoms.
- The pain is usually in the upper central portion of the abdomen (the "pit" of the stomach).
- Sometimes gastritis pain occurs in the left upper portion of the abdomen and in the back. The pain seems to "go right straight through."
- People often use the terms burning, aching, gnawing, or soreness to describe the pain. Usually, a vague sense of discomfort is present, but the pain may be sharp, stabbing, or cutting.
Other symptoms of gastritis include the following:
- Belching: Belching usually either does not relieve the pain or relieves it only briefly.
- Nausea and vomiting: The vomit may be clear, green or yellow, blood-streaked, or completely bloody, depending on the severity of the stomach inflammation.
- Feeling of fullness or burning in the upper part of the belly
In more severe gastritis, bleeding may occur inside the stomach. Erosive gastritis causes an erosion of the gastric mucosa leading to bleeding.
Any of the following symptoms can be seen as well as those already mentioned.
- Pallor, sweating, and rapid (or "racing") heartbeat.
- Feeling faint or short of breath
- Chest pain or severe stomach pain
- Vomiting large amounts of blood
- Bloody bowel movements or dark, sticky, very foul-smelling bowel movements
Any or all of these symptoms can occur suddenly. This is particularly true in adults older than 65 years of age.
What Causes Gastritis?
Gastritis is associated with various medications, medical and surgical conditions, physical stresses, social habits, chemicals, and infections. Some of the more common causes of gastritis are listed.
Medications (only the most common medications are listed)
Swallowing chemicals or objects
- Corrosives (acid or lye)
- Swallowed foreign bodies (paper clips or pins)
Medical and surgical conditions
- People who are critically ill or injured can develop gastritis.
- After medical procedures (such as endoscopy, in which a specialist looks into the stomach with a small lighted tube)
- After an operation to remove a part of the stomach
- After radiation treatment for cancer
- Autoimmune diseases
- Chronic vomiting
- Alcohol consumption
- Autoimmune gastritis: your body attacks the cells that line your stomach. This is usually found in people with underlying autoimmune disorders.
- Eosinophilic Gastroenteritis: An uncommon form of gastritis due to eosinophilic infiltration of the stomach wall.
- Bile reflux gastritis: This condition is a post-gastrectomy complication leading to stomach pain, vomiting bile and weight loss.
What Medications Should You Avoid With Gastritis?
Sometimes a person cannot avoid certain substances that cause gastritis.
- The health care professional may have a good reason to recommend aspirin, iron, potassium, or some other medication that causes gastritis.
- If the person develops minor gastritis symptoms, it may be best to continue the recommended medication and treat the gastritis symptoms.
- Consult a health care professional before stopping any medication.
In the case of aspirin, coated aspirin may not cause the same symptoms because:
- Coated aspirin does not dissolve in the stomach.
- Consult the health care professional before stopping any medication you have been prescribed.
The health care professional may recommend that nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin, Nuprin) be taken with food or with antacids. Doing this may lessen the chance of developing gastritis symptoms.
Switching from aspirin or NSAIDs to another pain reliever may help as well. Acetaminophen (Tylenol, Panadol) is not known to cause gastritis.
- Talk with a health care professional before switching to acetaminophen.
- He or she may have recommended aspirin or an NSAID for a specific purpose.
Foods to Avoid With Gastritis (Gastritis Diet)
Changes to your diet can also help improve your symptoms. Common avoidable triggers of gastritis symptoms include:
- Spicy foods
- Coffee and other beverages and drinks that contain caffeine (for example, colas and teas)
- Fatty foods
- Fried foods
Several small meals a day also can help gastritis symptoms.
(See "Causes" for a more complete list.)
When to Seek Medical Care for Gastritis
See your health-care professional if your symptoms are new, long-lasting, or worsen despite self-care.
Seek immediate medical attention if you have any of the following symptoms.
- Vomiting that does not allow the affected person to take food, fluids, and medications
- Fever with abdominal pain
- Fainting or feeling faint
- Rapid heartbeat
- Unexplained sweating
- Repeated vomiting of green or yellow material
- Vomiting any amount of blood
- Shortness of breath
- Chest pain
How Is Gastritis Diagnosed?
The diagnosis of gastritis may be established by a complete history and physical. Some cases may require blood tests and other tests (endoscopy) or a consultation with a specialist (usually a gastroenterologist).
The health care professional first interviews the person about their symptoms, medical history, habits and lifestyle, and any medications that are taken by the patient.
- This information is enough to make the diagnosis in many people.
- Be sure to tell the doctor about all the medications the patient takes, including nonprescription drugs, herbal and botanical preparations, and supplements such as vitamins.
- Also report any measures the patient has taken to relieve the symptoms and how well those measures worked.
Laboratory testing: Tests are available for the most common bacterial organism that causes ulcers that can lead to gastritis
- Often, no tests are necessary.
- If the health care professional orders tests, it is probably to rule out certain medical conditions that can cause gastritis or mimic gastritis.
- Once all other possibilities are ruled out, that leaves gastritis as the most likely cause of the patient's symptoms.
The following tests are most likely to be ordered:
- H. Pylori test
- Blood cell counts (looking mostly for anemia, a low blood count)
- Liver and kidney functions
- Gallbladder and pancreas functions
- Pregnancy test
- Stool test to check for blood
X-rays films or other diagnostic images may be ordered, although they are usually not necessary.
An electrocardiogram (ECG, EKG) might be ordered if the patient's heartbeat is rapid or they are having chest pain.
The patient may be referred to a gastroenterologist, a doctor who specializes in diseases of the digestive system.
- The gastroenterologist may in turn recommend an endoscopy.
- During the endoscopy, a thin, flexible probe with a tiny camera at the end is passed into the stomach for a direct look.
- At the same time, samples of the stomach lining can be taken to test for a wide variety of conditions.
What Is the Treatment for Gastritis?
Once the diagnosis of gastritis has been confirmed by a medical professional, treatment can begin. The choice of treatment depends to some extent on the cause of the gastritis. Some treatments target the exact cause of a particular type of gastritis. Most treatments aim at reducing stomach acid and symptoms. The patient's stomach often will heal over time if the underlying cause is identified and corrected.
If a person has gastritis they should avoid substances that trigger gastritis symptoms.
- Almost all health care professionals would recommend this as the first step in preventing gastritis.
- First, the person has to identify the triggers of gastritis.
- Most people are aware of their triggers before seeking medical care.
- If a person does not know what triggers their gastritis, a health-care professional can assist them in determining the triggers.
What OTC and Prescription Medications Treat Gastritis?
If gastritis symptoms continue, antacids are sometimes recommended. Three main types of antacids are available. All three are about equal in effectiveness.
- Magnesium-containing antacids may cause diarrhea. People with certain kidney problems should use these cautiously or not at all.
- Aluminum-containing antacids can cause constipation.
- Calcium-containing antacids have received a great deal of attention for their ability to control stomach acid and also supplement body calcium. Calcium supplementation is most important for postmenopausal women. Calcium-based antacids can also lead to constipation.
- Antacids may also change the body's ability to absorb certain other medications. Only take medications with antacids after checking with a pharmacist or doctor.
- If the patient requires an antacid more than occasionally, consult a health care professional as they can decide which one is best for the patient.
Stronger medications that protect the stomach's lining or lessen acid production in the stomach are available by prescription. Talk to a health-care professional if the nonprescription medications do not work.
Histamine (H2) blockers have received a lot of attention for stomach problems.
- Some of these medications, for example, cimetidine (Tagamet) and ranitidine (Zantac), are available without a prescription.
- Histamine blockers work by reducing acid secretion in the stomach.
- This reduces gastritis pain and other symptoms.
- If a person needs one of these medications regularly, a health-care professional should be consulted for recommendations.
Proton pump inhibitors (PPIs): These medications are very powerful blockers of the stomach's ability to secrete acid.
- A health care professional who prescribes one of these medications to treat the patient's gastritis may be doing so in consultation with a gastroenterologist.
- Examples of PPIs include lansoprazole (Prevacid) and omeprazole (Prilosec, Losec).
Coating agents: These medications protect the stomach's lining.
- Sucralfate (Carafate): Coats and protects the stomach lining
- Misoprostol (Cytotec): Also protects the stomach lining. It is used as a preventive measure for people taking NSAIDs who are at a high risk of developing stomach damage
Antibiotics: An antibiotic may be prescribed if H pylori is the cause of the patient's gastritis.
Antiemetics: Antiemetic medications help control nausea and vomiting. A number of different antiemetics can be used to control gastritis symptoms. Some of these medications are available by prescription for home use as well. Note that these medications do not improve the gastritis, but rather only decrease the symptoms of gastritis.
Should I Follow-up With My Doctor After Being Treated for Gastritis?
- Avoid substances that irritate the stomach or cause symptoms.
- Take all medications as prescribed by the health care professional.
- Return for medical attention if symptoms worsen or persist.
- Report any new symptoms to a health care professional.
How Can Gastritis Be Prevented?
If a person knows what causes their gastritis, the simplest approach is to avoid the cause.
- Aspirin and alcohol are the two most widely used substances that cause gastritis.
- Alcohol should be avoided if the person develops an upset stomach and nausea after drinking alcohol.
The mainstay of gastritis prevention is to avoid those things that irritate or inflame the stomach's lining.
- Aspirin (use coated aspirin if the person must take aspirin)
- NSAIDs such as ibuprofen (Motrin, Advil) or naproxen (Naprosyn)
- Caffeine and other caffeine-like substances
If the patient's health care professional has prescribed a medication that they think is causing gastritis symptoms, talk to the doctor before you stop taking the medication. The medication may be very important for the patient's health.
What Is the Outlook for a Person With Gastritis?
Most people recover from gastritis. Depending on the many factors that affect the stomach lining, gastritis symptoms may flare-up from time to time. Overall, gastritis is a common ailment that responds well to simple treatments.
On occasion, rare forms of gastritis can be serious or even life-threatening. Severe, ongoing symptoms or internal bleeding should alert a health-care professional to search for a more serious underlying cause.
Wehbi, M. MD. "Acute Gastritis Treatment and Management." Medscape. Feb 25, 2016.