Gastritis: Causes, Symptoms, Treatment, and Prevention


What is gastritis?

Gastritis is a common digestive disorder characterized by inflammation of the lining of the stomach. It can be acute or chronic and may result from various factors, including infection, medication use, stress, or autoimmune diseases. This article aims to provide a comprehensive overview of gastritis, including its causes, symptoms, treatment options, and preventive measures.

What are the causes of gastritis?

Gastritis can be caused by various factors, including:

  1. Helicobacter pylori infection: This bacterium is the most common cause of gastritis. It infects the stomach lining, leading to inflammation. H. pylori is usually contracted through contaminated food or water, and it can persist in the stomach for years if left untreated.
  2. Nonsteroidal anti-inflammatory drugs (NSAIDs): Medications like aspirin, ibuprofen, and naproxen can irritate the stomach lining, leading to gastritis. Prolonged or high-dose NSAID use increases the risk.
  3. Excessive alcohol consumption: Alcohol can irritate and damage the stomach lining, causing acute or chronic gastritis. Heavy and long-term alcohol consumption is particularly associated with an increased risk.
  4. Stress: While stress itself may not directly cause gastritis, it can contribute to its development or exacerbate existing gastritis. Severe stress can increase stomach acid production, making the lining more susceptible to inflammation.
  5. Autoimmune disorders: In some cases, the immune system mistakenly attacks the cells of the stomach lining, leading to chronic autoimmune gastritis. This condition is more common in individuals with other autoimmune disorders, such as Hashimoto’s thyroiditis or type 1 diabetes.
  6. Bile reflux: When bile, a digestive fluid produced by the liver, flows back into the stomach, it can irritate and inflame the stomach lining, leading to gastritis.
  7. Other causes: Gastritis can also be caused by viral or bacterial infections other than H. pylori, such as herpes simplex virus or cytomegalovirus. Certain digestive diseases, such as Crohn’s disease or pernicious anemia, can also contribute to gastritis.

Some individuals may have gastritis without a clear identifiable cause. Additionally, factors such as genetics, lifestyle choices, and overall health can influence an individual’s susceptibility to gastritis.

What is autoimmune gastritis?

Autoimmune gastritis, also known as autoimmune metaplastic atrophic gastritis (AMAG), is a chronic inflammatory condition of the stomach lining that occurs due to an autoimmune response. In this condition, the immune system mistakenly attacks the cells of the stomach lining, leading to inflammation and damage over time.

Here are some key aspects of autoimmune gastritis:

  1. Autoimmune response: In autoimmune gastritis, the immune system produces antibodies that target the parietal cells and intrinsic factor in the stomach lining. Parietal cells produce stomach acid and intrinsic factor, a protein necessary for the absorption of vitamin B12. The immune system’s attack on these cells leads to their destruction.
  2. Pernicious anemia: The destruction of parietal cells in autoimmune gastritis results in decreased production of stomach acid and intrinsic factor. Insufficient stomach acid impairs the absorption of vitamin B12 from food, leading to a condition called pernicious anemia. Vitamin B12 deficiency can cause fatigue, weakness, neurological symptoms, and other complications.
  3. Metaplastic changes: Over time, the chronic inflammation and damage to the stomach lining can trigger metaplastic changes. Metaplasia refers to the abnormal transformation of cells from one type to another. In autoimmune gastritis, metaplastic changes can lead to the replacement of normal stomach lining cells with intestinal-type cells, a condition known as intestinal metaplasia.
  4. Increased risk of gastric cancer: Autoimmune gastritis, especially in the presence of intestinal metaplasia, can increase the risk of developing gastric cancer. The risk is highest in individuals with extensive metaplastic changes and long-standing autoimmune gastritis.
  5. Association with other autoimmune disorders: Autoimmune gastritis is often associated with other autoimmune conditions, such as Hashimoto’s thyroiditis, type 1 diabetes, or Addison’s disease. These conditions may share common genetic or immunological factors that contribute to the development of autoimmune gastritis.

Diagnosis of autoimmune gastritis involves a combination of medical history assessment, physical examination, blood tests to detect specific antibodies (such as anti-parietal cell antibodies and anti-intrinsic factor antibodies), and endoscopy with biopsy to examine the stomach lining for signs of inflammation and metaplasia.

Management of autoimmune gastritis typically involves lifelong vitamin B12 supplementation to address pernicious anemia and regular monitoring for the development of gastric cancer. Treatment for associated autoimmune conditions may also be necessary. Close collaboration with a healthcare professional is crucial for diagnosis, treatment, and monitoring in cases of autoimmune gastritis.

What are the symptoms of gastritis?

The symptoms of gastritis can vary in intensity and duration depending on the underlying cause, the severity of inflammation, and individual factors. Here are some common symptoms associated with gastritis:

  1. Upper Abdominal Pain or Discomfort: This is one of the most common symptoms of gastritis. The pain is usually located in the upper central abdomen, just below the sternum (breastbone). It may be described as a burning, gnawing, or dull ache. The pain may worsen after eating or on an empty stomach.
  2. Nausea and Vomiting: Gastritis can cause feelings of nausea and an urge to vomit. In some cases, vomiting may occur, which may provide temporary relief but does not address the underlying cause.
  3. Indigestion or Bloating: Gastritis can lead to indigestion, characterized by a sense of fullness, discomfort, or bloating in the upper abdomen after eating a meal.
  4. Loss of Appetite: Many individuals with gastritis experience a decreased appetite and may feel full even after eating small amounts of food.
  5. Heartburn or Acid Reflux: Gastritis can cause the stomach acid to irritate the lower esophagus, leading to a burning sensation in the chest (heartburn) or acid reflux, where stomach acid flows back into the throat, causing a sour or bitter taste.
  6. Dark or Black Stools: Gastrointestinal bleeding resulting from severe gastritis can lead to the passage of dark, tarry stools called melena. This indicates the presence of blood in the digestive tract.
  7. Fatigue and Weakness: Chronic gastritis, particularly when associated with conditions like pernicious anemia, can lead to a deficiency in vitamin B12 and iron. This can cause fatigue, weakness, and general malaise.
  8. Weight Loss: In chronic cases of gastritis, individuals may experience unintentional weight loss due to reduced appetite, malabsorption of nutrients, and overall inflammation affecting the body’s metabolic processes.

Not everyone with gastritis experiences the same set of symptoms. Additionally, some individuals with gastritis may be asymptomatic, especially in the early stages or in cases of mild inflammation.

Diagnosis of gastritis

Diagnosing gastritis involves a combination of medical history assessment, physical examination, and specific diagnostic tests. Here are the common steps involved in diagnosing gastritis:

  1. Medical History Assessment: Your gastroenterologist will ask you about your symptoms, their duration and severity, any factors that worsen or alleviate the symptoms, and your medical history. Providing information about your diet, lifestyle, and any medications or supplements you are taking is important for identifying potential causes or risk factors for gastritis.
  2. Physical Examination: A physical examination may be conducted to assess abdominal tenderness, bloating, or any other signs that may suggest gastritis or other related conditions.
  3. Blood Tests: Blood tests can provide valuable information in diagnosing gastritis. These tests may include:
    • Complete blood count (CBC): It helps to evaluate for anemia or signs of infection.
    • Tests for H. pylori infection: These include antibody tests, stool antigen tests, or urea breath tests to detect the presence of H. pylori bacteria.
    • Vitamin B12 levels: Low levels may indicate pernicious anemia associated with autoimmune gastritis.
  4. Stool Tests: Stool tests may be conducted to check for the presence of blood (occult blood) in the stool or to detect H. pylori infection.
  5. Endoscopy: A commonly used procedure for diagnosing gastritis is an upper endoscopy (also known as esophagogastroduodenoscopy or EGD). It involves the insertion of a thin, flexible tube with a light and camera (endoscope) into the esophagus, stomach, and duodenum. This allows the doctor to visually examine the stomach lining for signs of inflammation, erosions, or ulcers. During the procedure, biopsies (small tissue samples) may be taken from the stomach lining for further examination under a microscope.
  6. Imaging Tests: In certain cases, imaging tests such as X-rays or abdominal ultrasound may be recommended to evaluate the digestive system, rule out other conditions, or assess the extent of gastritis.
  7. Other Tests: In some instances, additional tests such as a gastric emptying study or a pH monitoring test may be conducted to evaluate the movement of food through the stomach or measure the amount of acid reflux.

Is gastritis diagnosis based on histology?

Yes, histology plays a crucial role in the diagnosis of gastritis. When an upper endoscopy (EGD) is performed to examine the stomach lining, biopsies (small tissue samples) are taken. These biopsies are then sent to a laboratory for histological examination by a pathologist.

Histology allows the pathologist to analyze the cellular changes and microscopic characteristics of the stomach tissue, which helps in confirming the diagnosis of gastritis and determining its specific type. The histological evaluation provides valuable information about the degree and extent of inflammation, the presence of specific cellular changes, and any associated complications or abnormalities.

During the histological examination, the pathologist looks for several key features, including:

  1. Inflammatory cell infiltration: The presence of inflammatory cells, such as lymphocytes, plasma cells, neutrophils, or eosinophils, in the stomach lining indicates inflammation.
  2. Epithelial changes: Histology can reveal changes in the stomach lining epithelial cells, such as damage, degeneration, or metaplastic changes (transformation of one cell type to another).
  3. Mucosal changes: The pathologist examines the characteristics of the mucosal layer, including thickness, integrity, and presence of erosions or ulcers.
  4. H. pylori infection: If H. pylori infection is suspected, the histological examination can detect the presence of H. pylori bacteria in the stomach tissue.

Histology is particularly important in distinguishing different types of gastritis, such as autoimmune gastritis, H. pylori-associated gastritis, or chemical-induced gastritis. It can also help identify any complications or pre-cancerous changes, such as intestinal metaplasia or dysplasia.

Combining the findings from the medical history, physical examination, endoscopy, and histological examination allows for a comprehensive diagnosis of gastritis and helps guide appropriate treatment and management strategies.

Treatment options for gastritis

a. Medications:

  • Proton pump inhibitors (PPIs) to reduce stomach acid production and promote healing
  • Antibiotics to eradicate H. pylori infection
  • Antacids or H2 blockers to relieve symptoms and reduce acid production
  • Chios mastic gum

b. Lifestyle Changes:

  • Avoiding triggers such as alcohol, tobacco, and certain medications
  • Adopting a healthy diet with smaller, more frequent meals
  • Managing stress levels through relaxation techniques or counseling
  • Maintaining a healthy weight and engaging in regular exercise

Gastritis diet

While there is no specific diet that universally applies to all individuals with gastritis, making certain dietary changes can help alleviate symptoms and promote healing. Here are some general guidelines for a gastritis-friendly diet:

  1. Avoid or limit irritants: Certain foods and beverages can irritate the stomach lining and worsen gastritis symptoms. These include spicy foods, acidic foods and drinks (such as citrus fruits, tomatoes, coffee, and carbonated beverages), alcohol, and high-fat foods. It’s best to avoid or limit these items in your diet.
  2. Opt for a bland diet: Stick to foods that are gentle on the stomach. Choose low-fat, easily digestible options such as lean proteins (chicken, fish, tofu), cooked vegetables, whole grains (rice, oats), and non-citrus fruits (bananas, apples).
  3. Consume fiber-rich foods: Fiber can help regulate digestion and promote a healthy gut. Include high-fiber foods like whole grains, legumes (beans, lentils), fruits (berries, pears), and vegetables (broccoli, carrots) in your meals. However, if high-fiber foods worsen your symptoms, you may need to reduce the fiber intake temporarily.
  4. Eat small, frequent meals: Large meals can put additional stress on the stomach. Opt for smaller, more frequent meals throughout the day to ease digestion and prevent overloading the stomach.
  5. Drink plenty of water: Staying hydrated is important for overall digestive health. Drink an adequate amount of water throughout the day, but avoid drinking large amounts of fluids during meals, as it can contribute to feelings of fullness and discomfort.
  6. Limit caffeine intake: Caffeine can stimulate acid production in the stomach, potentially aggravating gastritis symptoms. Reduce or avoid coffee, tea, and other caffeinated beverages. Opt for herbal teas or decaffeinated options instead.
  7. Manage stress: Emotional stress can exacerbate gastritis symptoms. Incorporate stress-management techniques like meditation, deep breathing exercises, or engaging in activities that help you relax and unwind.

Gastritis: complications and long-term outlook

  1. Untreated or severe gastritis can lead to complications such as peptic ulcers, bleeding, or stomach lining erosion.
  2. Chronic gastritis may increase the risk of developing stomach cancer in some cases.

Gastritis prevention

  1. Proper hygiene practices, such as regular handwashing, to minimize the risk of H. pylori infection
  2. Limiting alcohol consumption and avoiding tobacco use
  3. Using medications like NSAIDs cautiously and under medical supervision
  4. Managing stress effectively through relaxation techniques or therapy
  5. Following a well-balanced diet and maintaining a healthy lifestyle

Concluding remarks

Gastritis is a common digestive condition characterized by inflammation of the stomach lining. It can cause discomfort, pain, and other digestive symptoms. Understanding the causes, symptoms, treatment options, and preventive measures can help individuals effectively manage gastritis and reduce the risk of complications. Consult a gastroenterologist for a proper diagnosis and personalized treatment plan based on individual circumstances.

How can I contact gastroenterologist Dr. Zavos to arrange an appointment?

Dr. Chris Zavos is a board-certified gastroenterologist and hepatologist, located in Thessaloniki Greece, and specifically in Kalamaria suburb, about 7 kilometres (4 miles) southeast of downtown Thessaloniki. His private office is at: Fanariou 8 street (near Aigaiou and Adrianoupoleos avenues), Kalamaria (Thessaloniki), Greece.

Thessaloniki International Airport is only 10 km away from his private office in Kalamaria and can be reached by taxi within 13 minutes from the airport.

Dr. Chris Zavos performs endoscopies at Bioclinic private hospital in downtown Thessaloniki (Mitropoleos 86 street).

You can contact Dr. Zavos at phone numbers: (+30)-6976596988 and (+30)-2311283833, or you can email him at Dr. Zavos responds to Greek and English languages.

Last update: 26 September 2023, 18:59


Gastroenterologist - Hepatologist, Thessaloniki

PhD at Medical School, Aristotle University of Thessaloniki, Greece

PGDip at Universitair Medisch Centrum Utrecht, The Netherlands

Ex President, Hellenic H. pylori & Microbiota Study Group