Gastritis

Understanding gastritis

What gastritis is

Gastritis is inflammation of the stomach lining, confirmed properly by examining the lining and, where needed, by biopsy. It is not the same as indigestion, though the words are often used interchangeably in clinic.

Acute gastritis comes on quickly and settles once the cause is removed. Chronic gastritis develops slowly over months or years, and is the form that occasionally leads to longer-term changes in the lining.

Understanding gastritis

Common causes

Gastritis is a description, not a diagnosis. The useful question is always what is causing it:

• H. pylori infection, the commonest cause of chronic gastritis worldwide
• Anti-inflammatory painkillers such as ibuprofen, diclofenac and aspirin
• Heavy or regular alcohol use
• Severe physical stress from major illness, burns or surgery
• Bile refluxing back from the small intestine into the stomach
• Autoimmune gastritis, where the body attacks its own stomach lining, which can cause vitamin B12 deficiency

Understanding gastritis

Symptoms

Many people with gastritis on endoscopy have no symptoms at all, and many people with symptoms turn out to have a normal-looking stomach. Where symptoms do occur they include a gnawing or burning discomfort in the upper abdomen, nausea, a feeling of fullness after small meals, bloating and loss of appetite.

Because these overlap almost completely with ulcer disease and with functional indigestion, symptoms alone cannot distinguish between them.

Understanding gastritis

When it needs investigating

Short-lived symptoms in a young person with an obvious trigger, such as a course of painkillers, can reasonably be treated without a camera.

A gastroscopy is warranted when symptoms persist beyond a few weeks, recur repeatedly, begin after the age of 45, or come with any alarm feature. The purpose is to identify the cause, exclude an ulcer or anything more serious, and test for H. pylori from a biopsy.

Understanding gastritis

Treatment

Treatment follows the cause rather than the label. If H. pylori is present, clearing it resolves the inflammation. If painkillers are responsible, stopping them is the treatment. Acid-reducing medication settles symptoms and allows the lining to recover in the meantime.

Where autoimmune gastritis is diagnosed, the focus shifts to monitoring and replacing vitamin B12, since the stomach can no longer absorb it properly.

• Avoid anti-inflammatory painkillers unless prescribed and necessary
• Reduce alcohol, and stop smoking
• Eat smaller, more regular meals during a flare
• Do not settle for a permanent prescription without knowing the cause