Gastritis

What is gastritis?

Gastritis is an inflammation of the lining of the stomach. Inflammation is when part of the body becomes hot, red, swollen and painful as a response to injury. In the stomach, this inflammation can occur in response to a bacteria or as a result of damage to the lining of the stomach (for example, from smoking or alcohol use). Because the stomach needs to produce acid to break down foods, this acid can make the inflammation worse. Therefore, reducing the acid is the main treatment for gastritis.

Gastritis symptoms

Many people with gastritis don't have any symptoms. However, gastritis can cause indigestion (dyspepsia).

Symptoms of gastritis may start suddenly and resolve quickly (acute gastritis) or may develop slowly and last for a long period of time (chronic gastritis).

Pain in the upper abdomen just below the breastbone (sternum) is the most common symptom. It usually comes and goes and may be worse on lying down. It may be eased by taking antacid tablets. Sometimes food can make the pain worse.

Other gastritis symptoms which may occur include:

• Loss of appetite.

• Bloating.

• Retching.

• Feeling sick (nausea).

• Being sick (vomiting).

• Feeling particularly 'full' after a meal.

What else might it be?

Don't assume that pain in the upper abdomen is always a sign of gastritis - the pain could be caused by a wide range of other things, such as a non-ulcer dyspepsia, duodenal ulcer, stomach ulcer, gallstones or irritable bowel syndrome. See the separate leaflet called Abdominal pain.

How long does gastritis last?

The length of symptoms can vary depending on the cause and how actively it is managed, either by lifestyle change or medication or a combination of both.

What causes gastritis?

The stomach normally produces acid to help with the digestion of food in your digestive tract and to kill bacteria.

This acid is corrosive so some cells on the inside lining of the stomach produce a natural mucous barrier. This protects the lining of the stomach and the first part of the small intestine (the duodenum).

There is normally a balance between the amount of acid being made and the mucous defence barrier. Gastritis may develop if there is an alteration in this balance, allowing the acid to damage the lining of the stomach. This alteration can be caused by:

Infection with Helicobacter pylori

Infection with Helicobacter pylori is present in about 6 in 10 cases of chronic gastritis. The test for this is via a simple stool test. Worldwide more than 2 in 3 people have H. pylori and it is found in around 4 in 10 people in the UK. As it is so common, it is not certain that H. pylori is the cause of the symptoms in all people with gastritis and H. pylori. See the separate leaflet called Helicobacter pylori for more information.

Anti-inflammatory medicines

Anti-inflammatory medicines are sometimes called NSAIDs. Many people take an anti-inflammatory medicine for joint inflammation (arthritis), muscular pains, etc.

These medicines sometimes affect the mucous barrier of the stomach and allow acid to cause inflammation or an ulcer.

Smoking

Smoking is a common cause of gastritis. It also increases the risk of stomach cancer.

Other causes

Less common causes of gastritis include:

• A stressful event - such as a bad injury or critical illness, or major surgery.

• An autoimmune reaction - when the immune system mistakenly attacks the body's own cells and tissues. (This may happen alongside have another autoimmune condition, such as Hashimoto's thyroid disease or type 1 diabetes).

• Cocaine use.

• Drinking too much alcohol.

• Viruses, parasites, fungi and bacteria other than H. pylori.

Diagnosing gastritis

A GP can usually make a diagnosis of gastritis by taking a history of the symptoms and an examination of the abdomen. Mild gastritis does not usually need any tests.

If gastritis doesn't get better quickly, or causes severe pain, then the GP may arrange some tests. These tests may include:

• Blood tests, including a test for anaemia, as gastritis occasionally causes some bleeding from your stomach lining.

• A test to detect the Helicobacter pylori bacteria. H. pylori can be detected in a stool test (faeces), or from a biopsy sample taken during an endoscopy. See the separate leaflet called Helicobacter pylori for more details.

• Gastroscopy (endoscopy) - this test can confirm gastritis. In this test a clinician looks inside the stomach by passing a thin, flexible telescope down the gullet (oesophagus). Small samples (biopsies) are usually taken of the stomach lining during endoscopy. These are sent to the laboratory to be looked at under the microscope. This also checks for stomach cancer.

Gastritis treatment

Lifestyle changes

It is sensible to try treating indigestion and upper stomach (epigastric) pain with changes to diet and lifestyle such as:

• Eating smaller and more frequent meals.

• Avoiding irritating foods, such as spicy, acidic (for example, fruit juices), fried or fatty foods.

• Not drinking any alcohol.

• Stopping smoking.

• Reducing stress.

• Stopping non-steroidal anti-inflammatory drugs (NSAIDs) and switching to a different painkiller if needed, such as paracetamol.

Acid-suppressing medication

• Antacids can be used as a treatment for gastritis to reduce the amount of acid in your stomach and allow the gastritis resolve.

• If treatment with antacid medicine is not enough, then a medicine called an H2 blocker (such as famotidine) may be used.

• An alternative medicine that may be used is a proton pump inhibitor (PPI) such as lansoprazole or omeprazole.

See the separate leaflet called Indigestion medication for more information.

If the gastritis is caused by Helicobacter pylori (H. pylori)

The tests may show an infection with H. pylori. This can be treated with a combination of antibiotics and proton pump inhibitors. H. pylori treatment should not be used without confirmed H. pylori on a stool test. See the separate leaflet called Helicobacter pylori for more details about the treatment for H. pylori infection.

If the gastritis is caused by an anti-inflammatory medicine

It is important to stop the anti-inflammatory medicine where possible. This allows the gastritis to heal. Acid-suppressing medicine will also usually be prescribed for several weeks. This stops the stomach from making acid and allows the gastritis to heal.

It may not always be possible to stop the medication. Aspirin will often be needed, for example following a heart attack or stroke. Anti-inflammatory medication may occasionally be the only medication suitable for pain.

It is important to discuss symptoms of gastritis with a doctor if it could be caused by medication as there may be alternative medications that could help. If not, another option is to take an acid-suppressing medicine each day indefinitely. This reduces the amount of acid made by the stomach and greatly reduces the chance of gastritis forming again.

When to see your doctor about gastritis

Seek medical attention if there is:

• Severe abdominal pain.

• Abdominal pain or any other indigestion symptoms lasting for more than a week.

• The gastritis starts after taking any medicine (prescription or over-the-counter).

• Weight loss without deliberately trying to diet.

• Difficulty swallowing, as if food is getting stuck.

Complications of gastritis

Gastritis usually resolves without any complications. Very occasionally gastritis may develop into a stomach ulcer. This used to be more common but is less so nowadays with newer better treatments.

Bleeding from the stomach lining may occur. This may cause vomiting of blood (haematemesis)or blood in the stools (often dark black tarry blood). If the bleeding is slow, there may be no obvious symptoms but a blood test may show anaemia.