Digestive symptoms

Gastritis

Also called: stomach inflammation, stomach lining inflammation

Gastritis is inflammation of the stomach lining. It can be acute (sudden, often from infection or a heavy NSAID dose) or chronic (longer-term, often from H. pylori or autoimmune disease). Symptoms include upper abdominal pain, nausea, fullness after small meals, and indigestion. Most cases are diagnosed and treated based on symptoms; severe or persistent cases need endoscopy.

What's actually inflamed

The stomach lining has several layers, including a mucus layer that protects against the acid the stomach itself produces. When that protective layer is damaged or the immune system targets the lining, inflammation results. Mild gastritis causes discomfort. Severe gastritis can cause erosions or progress to ulcers.

Common causes

  • H. pylori infection (most common cause of chronic gastritis worldwide).
  • NSAIDs (ibuprofen, naproxen, aspirin), especially regular use.
  • Heavy alcohol use.
  • Bile reflux (in post-cholecystectomy or post-gastric surgery).
  • Autoimmune gastritis (immune system attacks parietal cells; causes B12 deficiency).
  • Severe stress (in critically ill patients, intensive care).
  • Less common: viral infections, eosinophilic gastritis, granulomatous gastritis.

Symptoms

  • Burning or gnawing pain in the upper abdomen.
  • Nausea, especially in the morning or on empty stomach.
  • Loss of appetite or fullness after small meals.
  • Bloating and burping.
  • Bad breath.
  • Sometimes black or tarry stools (suggests bleeding).
  • B12 deficiency in autoimmune gastritis (fatigue, tingling, mood changes).

How it's diagnosed

  1. Symptoms + history (NSAID use, alcohol, stress).
  2. H. pylori test: urea breath test or stool antigen.
  3. Blood test for B12 and parietal cell antibodies if autoimmune suspected.
  4. Endoscopy with biopsy is the gold standard but reserved for persistent symptoms or red flags.

Treatment

  • H. pylori positive: triple therapy (PPI + 2 antibiotics) for 7-14 days.
  • NSAID-induced: stop the NSAID; switch to paracetamol or topical NSAIDs.
  • Alcohol-induced: cut down or stop.
  • Symptomatic: PPI (omeprazole 20 mg) for 4-8 weeks. Step down after.
  • Autoimmune: B12 injections, monitor for gastric cancer risk over years.
  • Diet: avoid spicy, fatty, and very acidic foods during flares. No specific 'gastritis diet' has strong evidence beyond limiting irritants.

Common questions

Is gastritis the same as an ulcer?
Related but different. Gastritis is inflammation of the lining. An ulcer is a deeper hole through the lining. Untreated gastritis can progress to ulcer. Both share many causes (H. pylori, NSAIDs, alcohol).
Will it come back?
Often, if the underlying cause persists. H. pylori-related gastritis usually resolves with successful eradication. NSAID-related comes back if you restart. Autoimmune gastritis is chronic by nature.
Can stress cause gastritis?
Severe physical stress (critical illness, major surgery) can cause acute gastritis. Everyday emotional stress doesn't directly cause gastritis but worsens symptoms in someone who already has it.
Should I avoid coffee with gastritis?
During flares, yes. Coffee increases stomach acid production. Many people manage chronic gastritis fine with morning coffee but find afternoon coffee triggers symptoms. Adjust to your pattern.

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