Understanding Gastritis: Its Origins and Effective Management

Many people claim that gastritis cannot be fully cured and one has to bear it as a lifelong affliction once they get it. However, this is not accurate as acute and chronic gastritis can be effectively treated by identifying its root cause.

What gastritis is?

Gastritis is a disease that arises from inflammation of the stomach mucosa.

The cells in the stomach lining produce acid to aid digestion. Normally, the surface of the stomach is protected by a gel that neutralizes the acid and shields the stomach walls. However, various factors may cause the protective gel to diminish or become inadequate to withstand stomach acid. When this happens, the acid comes into contact with the stomach lining, leading to inflammation, or gastritis.

Many people mistake gastritis for functional dyspepsia, which is characterized by stomach discomfort, nausea, and early satiety without any apparent cause. Unlike gastritis, functional dyspepsia does not involve inflammation of the stomach.

Causes of Gastritis

Various factors can increase the risk of gastritis.

Infection

The Helicobacter pylori bacteria is responsible for causing gastritis in 90% of cases. Around 44% of the global population is infected with this bacterium, but most cases are asymptomatic, and gastritis does not develop. Helicobacter pylori is typically transmitted from person to person through saliva during activities such as kissing or sharing utensils.

Frequent use of painkillers

Painkillers such as aspirin, ibuprofen, and diclofenac can lead to gastritis by damaging the stomach’s protective lining.

Older age

Gastritis is more common among individuals over the age of fifty due to the thinning of the stomach mucosa that occurs with age, and the increased likelihood of contracting Helicobacter pylori.

Frequent alcohol consumption

Drinking alcohol can irritate the stomach lining, rendering it more susceptible to stomach acid.

Stress

Damage to the protective layer of the stomach resulting in gastritis can also occur due to surgical procedures, injuries, burns, and severe infections. In some cases, untreated depression or significant psychological stress can also lead to gastritis.

The types and forms of gastritis

The severity and underlying causes of gastritis determine its classification.

Based on severity, gastritis can be:

• Acute: developing rapidly and treatable within a few days
• Chronic: often emerging in childhood and remaining asymptomatic for several years or even decades. Acute gastritis can sometimes progress to chronic gastritis.

Based on causes, gastritis is categorized as:

• Infectious: caused by Helicobacter pylori bacteria
• Reactive: triggered by substances that irritate the stomach lining and damage its protective layer, such as alcohol, painkillers, and some antibiotics
• Autoimmune: characterized by the body’s immune system attacking the cells of the stomach lining. The cause of autoimmune gastritis is currently unknown.
• Other types: including radiation-induced, eosinophilic, and stress-induced gastritis. These forms are rare and beyond the scope of this article.

Infectious gastritis is the most prevalent type, accounting for 90% of all cases.

Symptoms of Gastritis

Symptoms of uncomplicated gastritis typically include:

• Dull pain and discomfort in the upper middle part of the abdomen
• Nausea and vomiting
• Feeling of fullness in the stomach, even after eating small amounts of food
• Loss of appetite
• Weight loss

Complications

If left untreated, gastritis can progress and damage the mucous membrane over time, leading to complications of the disease. The main complications include:

Gastric ulcer

When an ulcer appears, it causes a dull or burning pain on an empty stomach, especially at night, in addition to the usual symptoms of gastritis. The pain can be relieved by eating or taking medications that reduce the acidity of gastric juice. The consumption of food can help reduce the acidity of gastric juice by binding acid, thereby minimizing its irritating effect on the mucous membrane.

Rupture of the Stomach Wall (Perforation)

An ulcer can not only occur in the mucous layer but can also extend deeper into the submucosal, muscular, and outer layers that lie beyond the abdominal cavity. When the ulcer damages all layers, it can create a through-hole through which the stomach contents enter the abdominal cavity. Food contains numerous bacteria that can cause extensive inflammation in the abdominal cavity, leading to peritonitis. This critical condition is life-threatening, and without seeking medical help, a person with peritonitis may die within a few hours.

Bleeding ulcer

As an ulcer grows, it can harm the wall of a blood vessel, leading to bleeding in the stomach cavity. If a large vessel is affected, a person can lose 15-40% of their total blood volume within a few hours, which can be life-threatening.

The rupture of the stomach wall and bleeding are the leading causes of death among patients in surgical hospitals. Approximately 8.4% of patients die from a stomach wall rupture, and 5.2% from bleeding.

Pathological narrowing of the stomach (pyloric stenosis)

Sometimes, when a healed ulcer site forms a scar, it can obstruct the passage of food from the stomach to the intestine, which may result in malnutrition due to insufficient nutrient intake. Patients with stomach overfilling frequently experience vomiting.

Additionally, stomach cancer can develop from long-term inflammation of the mucous membrane and infection with Helicobacter pylori.

When to call for an ambulance

If the stomach wall ruptures and bleeding occurs, it can be a life-threatening condition that requires calling an ambulance. You can determine if a person’s life is in danger by looking out for the following symptoms:

• The stool has a tarry consistency and color and emits a foul odor.
• The person is vomiting something black, or there are visible blood vessels in their vomit.
• The person experiences sharp pain above the navel, as if they have been stabbed in that area.

Diagnosis of gastritis

During the appointment, the doctor interviews the patient to learn about their complaints. Typically, at this stage, the specialist can make a preliminary diagnosis. However, the doctor may need to prescribe additional tests to determine the exact cause and identify the presence of complications.

Test for Helicobacter pylori

The doctor may prescribe a breath test, a blood test for antibodies to Helicobacter pylori, or a stool test for Helicobacter pylori antigen to detect this bacterium. A positive result from any of these tests will determine the need for further treatment tactics, and the doctor will prescribe antibiotics to eliminate the infection.

Gastroscopy with biopsy (EGD)

In this procedure, the doctor examines the walls of the stomach using an endoscope, which is a flexible tube with a camera at the end. The endoscope enables the detection of suspicious areas of the stomach mucosa, such as an ulcer. The doctor can take a tissue sample from such an area and examine it in the laboratory. This process can help in detecting inflammation, cancer, or the presence of Helicobacter pylori.

Barium contrast X-ray

Under normal conditions, digestive organs are not visible on X-ray images as they are not dense enough to absorb X-rays. To visualize these organs, a liquid containing barium is given to the patient to drink. As the barium moves down the esophagus and enters the stomach, a series of X-ray images are taken. Barium absorbs X-rays, which helps the doctor assess the condition of the esophageal and gastric mucosa.

A barium contrast X-ray can detect an ulcer or pathological narrowing of the esophagus and stomach.

Depending on the suspected diagnosis, additional tests may be necessary, such as a test for antibodies to parietal cells of the stomach or the measurement of gastric acid secretion.

Do you always need a gastroscopy?

Gastritis is diagnosed histologically by taking a tissue sample, as visual inspection alone may not accurately determine if the stomach is inflamed, despite erosions and mucous membrane changes.

Gastroscopy is typically used to identify complications of gastritis, including ulcers, bleeding, stomach cancer, or early stages of cancer. A gastroscopy may also be recommended for individuals over 50 years of age or those with a family history of stomach cancer, as well as those experiencing certain symptoms, such as night pain, round-the-clock pain, fever accompanied by pain, or clear signs of bleeding like vomiting with blood clots.

However, gastroscopy is not necessary for diagnosing food poisoning. Sometimes, a gastroenterologist may not differentiate between uncomplicated gastritis and functional dyspepsia since their treatments are similar. These diagnoses are typically based on the patient’s complaints.

How the treatment of gastritis depends on its cause

If Helicobacter pylori infection is the cause of gastritis, the doctor will prescribe antibiotics to eradicate the bacteria. In addition, the treatment regimen will include drugs such as omeprazole that reduce the acidity of gastric juice. These drugs stimulate the active division of Helicobacter pylori, making it more susceptible to the action of antibiotics.

In autoimmune gastritis, excessive immune system activity damages the cells. Over time, the death of stomach cells and the resulting decrease in gastric juice acidity can lead to impaired vitamin B12 absorption. This vitamin is crucial for iron absorption, which, in turn, is essential for the creation of erythrocytes that carry oxygen. Therefore, with chronic gastritis, the body’s other cells may experience oxygen deficiency. To compensate for these changes, doctors may prescribe supplements of iron and vitamin B12.

Medication Therapy

The doctor accurately identifies the cause and confirms the presence of complications before prescribing drugs for gastritis. Without the help of a doctor, it is impossible to cure gastritis as the treatment depends on the cause of the disease.

Even chronic gastritis can be treated if the diagnosis is accurately established. However, consulting a doctor is necessary as it is impossible to determine whether it is gastritis or what its cause is without medical guidance. Drinking soda or aluminum-based antacids for years will not affect the cause of the disease, and over time, the symptoms will progress, eventually leading to complications.

I will now discuss the main groups of drugs used to treat various forms of gastritis.

Antibacterial agents

Doctors prescribe drugs such as amoxicillin, metronidazole, clarithromycin, and others to treat infectious gastritis. These medications are used to kill the bacterium Helicobacter pylori, which resides in the stomach.

Gastroprotective agents

Bismuth salts are the most commonly used drug in this group and are prescribed as part of treatment regimens for infectious gastritis. Bismuth citrate, for instance, kills Helicobacter pylori and prevents the bacterium from adhering to the mucous membrane of the stomach.

Proton pump inhibitors

Drugs such as omeprazole, lansoprazole, esomeprazole, and others are used to treat gastritis. They work by reducing the activity of the molecule-pump responsible for pumping acid out of the stomach cells. Additionally, these medications make Helicobacter pylori more susceptible to antibiotics and promote the rapid healing of stomach ulcers or duodenal ulcers.

Antacid agents

Metal salts, such as aluminum or magnesium hydroxide, neutralize acid in the stomach for a few minutes, providing only brief protection to the stomach mucosa. These drugs are primarily used symptomatically for acid reflux, rather than for gastritis.

Prokinetics

Prokinetics stimulate the peristalsis of the stomach and duodenum, enabling food to move more rapidly through the gastrointestinal tract. They are prescribed for gastritis and dyspepsia, which cause feelings of rapid satiety, bloating, nausea, and vomiting.

H2-receptor antagonists

These drugs decrease the production of gastric acid and reduce the sensitivity of stomach cells to nerve stimulation, resulting in lower acidity levels in the stomach. However, in practice, they are rarely utilized since they are noticeably weaker than proton pump inhibitors.

Vitamin B12 and iron preparations

Occasionally, they are employed for chronic gastritis, which can impede the absorption of vitamin B12 and iron.

Healthy Eating

Mayo Clinic recommends following three rules to reduce gastritis symptoms:

• Eat frequently but in smaller portions. For instance, have a snack or eat a small meal every three hours.
• Avoid foods that irritate the stomach lining, such as acidic foods like citrus fruits, fried, spicy, and fatty foods.
• Refrain from consuming alcohol as it can irritate the stomach lining.

Doctors advise against taking pain relievers like aspirin, ibuprofen, or acetylsalicylic acid for any form of gastritis. If you need to take them, consult with your doctor, who will prescribe medication that does not irritate the stomach lining as much.

How important is diet for gastritis

There is a lack of high-quality research on diets for gastritis and dyspepsia.

Typically, a doctor will conduct an interview with the patient to determine which foods cause stomach pain and discomfort. The doctor will then recommend removing these foods from the patient’s diet.

Establishing a regular eating pattern is also usually advised by the doctor, rather than the usual practice of eating once a day and going to bed. It is recommended to eat at least three times a day, as this helps the nervous system of the stomach to adapt and produce acid regularly. Naturally, products and medications that can trigger the development of gastritis, such as alcohol, tobacco, and nonsteroidal anti-inflammatory drugs, should be excluded from the diet.

Surgery

Surgery is not recommended for uncomplicated cases of gastritis. In most cases, medication therapy and dietary changes are sufficient, even if an ulcer appears on the mucous membrane.

Surgery is typically only considered in extreme cases, such as when an ulcer causes bleeding by damaging a blood vessel or if an ulcer leads to perforation or stenosis of the stomach wall.

Prevention

There are no guaranteed ways to prevent gastritis. However, Mayo Clinic recommends several measures to reduce the risk of infection with Helicobacter pylori and developing gastritis. These include washing hands with soap more frequently and cooking food thoroughly to prevent undercooking.

Remember

Gastritis is the inflammation of the stomach’s mucous membrane, often caused by an infection with Helicobacter pylori in 90% of cases. If left untreated, gastritis can lead to complications that may be life-threatening. Selecting the appropriate treatment requires establishing the underlying cause of gastritis. Fortunately, gastritis can be fully cured.

Sources:

• The physiology of hydrochloric acid secretion – article on UpToDate
• The gastroduodenal muco-bicarbonate barrier: protection against acid and pepsin – article in the American Journal of Cell Physiology
• Gastritis – Causes, Diagnosis and Treatment – Mayo Clinic article
• Global prevalence of Helicobacter pylori – meta-analysis
• Helicobacter-associated gastritis – article from Pabmed
• Transmission of Helicobacter pylori – article on the University of Arizona website
• Classification of gastritis and duodenitis – International classification of diseases, 10th edition
• Definition and facts about gastritis and gastropathy – an article on the website of the National Institute of Diabetes, Digestive and Kidney Diseases
• Pubmed article on chronic gastritis
• Peptic Ulcer at Mayo Clinic
• WebMD article on peritonitis
• Mayo Clinic article on gatekeeper stenosis