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Gastritis

Gastritis is an inflammation of the gastric mucosa—the inner lining of the stomach—caused by a variety of factors, including bacterial infections (particularly Helicobacter pylori), prolonged use of certain medications, alcohol consumption, and other irritants.

In most cases, gastritis is a manageable condition. However, if left untreated, it can lead to more serious complications such as ulcers or gastrointestinal bleeding.

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What Is Gastritis?

Gastritis is an inflammation of the gastric mucosa, the inner lining of the stomach that protects it from gastric acid. This inflammation weakens the stomach lining and impairs its ability to perform its normal functions.

Gastritis can occur in two main forms:

  • Acute gastritis: Symptoms develop suddenly and last for a short period (days or weeks). It is generally reversible with appropriate treatment.
  • Chronic gastritis: Persistent inflammation that lasts for months or years. It requires ongoing monitoring and long-term treatment to prevent complications.

In most cases, gastritis is a manageable and treatable condition. However, if it is not properly diagnosed and treated, or if symptoms persist despite therapy, it may progress to serious complications, including gastric ulcers, gastrointestinal bleeding, or, in rare cases, gastric cancer.

Causes and Risk Factors of Gastritis

Causes of Gastritis

Gastritis results from damage to or irritation of the stomach lining, which can become weakened for a variety of reasons.

Bacterial Infection

Helicobacter pylori is one of the most common causes of gastritis, particularly in chronic forms. This bacterium colonizes the stomach and causes persistent inflammation. In Italy, Helicobacter pylori infection remains relatively common, especially among older adults.

Drugs

Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs)—such as ibuprofen, aspirin, and naproxen—is a frequent cause of gastritis. These medications reduce the stomach's protective mechanisms. Other medications, including certain corticosteroids and bisphosphonates, may also increase the risk.

Alcohol

Excessive alcohol consumption directly irritates the stomach lining, compromising its protective defenses and promoting inflammation.

Environmental and Lifestyle Factors

  • Smoking: Impairs the stomach lining's protective mechanisms and may increase inflammation.
  • Poor diet: Fatty foods, highly spicy dishes, coffee, citrus fruits, and chocolate may irritate the gastric mucosa.
  • Chronic stress: Prolonged periods of psychological stress may contribute to the onset or progression of gastritis.

Specific Medical Conditions

  • Bile reflux: The backflow of bile into the stomach irritates the gastric lining.
  • Autoimmune diseases: In rare cases, the immune system attacks the stomach's own cells (autoimmune gastritis). This condition is more common in patients with other autoimmune disorders, such as celiac disease or Hashimoto's thyroiditis.
  • Chronic inflammatory diseases: Crohn's disease and other inflammatory gastrointestinal disorders may cause secondary gastritis.
  • Critical illnesses: Major surgery, severe trauma, or serious medical conditions can lead to stress-related acute gastritis.

Risk Factors for Gastritis

The risk of developing gastritis increases in the presence of:

  • Excessive alcohol consumption.
  • An unbalanced diet rich in irritating foods.
  • Older age, as the prevalence of gastritis increases among older adults.
  • Family history, particularly in autoimmune gastritis, which may have a genetic component.
  • Smoking.
  • Helicobacter pylori infection (the primary risk factor).
  • Uncontrolled chronic stress.
  • Regular use of NSAIDs.

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What Are the Symptoms of Gastritis?

The symptoms of gastritis can range from mild to severe, appearing suddenly (acute gastritis) or developing gradually over time (chronic gastritis). Not all people with gastritis experience noticeable symptoms.

The Most Common Symptoms of Gastritis

  • Burning sensation or pain in the upper abdomen (epigastric region): This is the most common symptom. The pain may be constant or intermittent and often worsens after meals or in certain situations.
  • Indigestion (dyspepsia): Slow digestion or a feeling of abdominal fullness.
  • Frequent belching.
  • Nausea: Sometimes accompanied by loss of appetite.
  • Loss of appetite or early satiety.
  • A feeling of heaviness or bloating after meals: Caused by impaired stomach function.
  • Vomiting: May occur in more acute cases.

Warning Signs (Severe Forms)

In some cases, particularly when gastritis is severe or left untreated for a long period, more serious symptoms may develop and require immediate medical attention:

  • Severe, persistent abdominal pain.
  • Black or very dark stools (melena): A sign of bleeding in the upper gastrointestinal tract.
  • Unintentional weight loss: Especially in chronic, uncontrolled cases.
  • Blood in the vomit (hematemesis) or vomit that resembles "coffee grounds", which may indicate stomach bleeding.

When to See a Doctor

You should consult a healthcare professional if:

  • You experience any warning signs (such as blood in the vomit or dark stools), which require prompt evaluation to rule out gastrointestinal bleeding.
  • You develop symptoms associated with anemia or malabsorption, such as weakness, fatigue, or pale skin, which may indicate chronic bleeding or impaired stomach function.
  • Symptoms persist for more than a few days or become severe, as medical evaluation is important to exclude complications.
  • Symptoms appear to be related to medication use: If symptoms begin after starting NSAIDs or other medications, your doctor may consider alternative treatments.

Note: Stomach pain and cramping do not necessarily indicate gastritis and may be related to other conditions, including gas buildup, irritable bowel syndrome (IBS), peptic ulcers, or pancreatitis. Only a medical evaluation can determine the underlying cause of your symptoms and establish the appropriate diagnosis.

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How Do You Diagnose Gastritis?

The diagnosis of gastritis is based on a thorough clinical evaluation supported by specific diagnostic tests. Establishing an accurate diagnosis is important because treatment depends on the underlying cause.

Initial Clinical Evaluation

During a gastroenterology consultation, the specialist will:

  • Collect a detailed medical history (anamnesis), including symptoms, their duration, their relationship to meals, medication use (particularly NSAIDs), dietary habits (alcohol, coffee, irritating foods), and stress levels.
  • Perform a physical examination, including abdominal palpation to identify areas of tenderness.
  • Review the patient's history of exposure and medical conditions, including medication use, previous infections, and associated autoimmune diseases.

Diagnostic Tests

Gastroscopy (Upper Gastrointestinal Endoscopy)

This is the primary diagnostic test for gastritis. It allows the physician to:

  • Directly examine the stomach lining and identify inflammation, erythema (redness), and possible ulcerations.
  • Perform biopsies (small tissue samples) for histological examination, which are essential for ruling out dysplasia or malignancy and for detecting Helicobacter pylori.
  • Assess the severity of the inflammation.

Gastroscopy is typically performed under sedation using a thin, flexible endoscope equipped with a light and video camera.

Helicobacter pylori Testing

Testing is essential to identify Helicobacter pylori infection:

  • Urea Breath Test (UBT): The patient ingests labeled urea, and the level of carbon dioxide (CO₂) in the exhaled breath is measured. This test is non-invasive, highly accurate, and widely used.
  • Gastric Biopsy Testing: Histological examination of tissue samples obtained during gastroscopy allows direct detection of the bacterium.
  • Serological Testing: Detects antibodies against H. pylori in the blood.
  • Stool Antigen Test: Identifies H. pylori antigens in stool samples (generally less sensitive than other tests).

Blood Tests

  • Complete Blood Count (CBC): Used to evaluate anemia, which may occur in cases of chronic bleeding.
  • Metabolic Panel and Liver Function Tests: Help exclude other medical conditions.
  • H. pylori Serology: Measures IgG and IgA antibodies against H. pylori.
  • Autoimmune Gastritis Tests: Includes testing for intrinsic factor antibodies and parietal cell antibodies when autoimmune gastritis is suspected.

Stool Testing

  • Fecal Occult Blood Test (FOBT): Detects gastrointestinal bleeding that may not be clinically apparent.
  • H. pylori Antigen Test: Used to detect active infection.

Gastric pH Assessment

In rare cases, such as suspected hyperacidic or hypoacidic gastritis, gastric pH may be measured to evaluate acid production.

The Importance of Early Diagnosis

A timely and accurate diagnosis can:

  • Rule out complications such as bleeding ulcers or malignancy.
  • Identify the specific cause of gastritis and guide targeted treatment.
  • Allow treatment to begin before chronic damage develops.
  • Monitor response to therapy and adjust the treatment plan as needed.

Complications of Gastritis

If not properly diagnosed and treated, gastritis can progress to serious complications, including:

  • Anemia: Resulting from chronic occult bleeding, particularly in chronic forms of gastritis.
  • Gastric Cancer: The risk increases in the presence of untreated H. pylori infection and persistent chronic gastritis.
  • Malabsorption: Impaired absorption of nutrients, particularly vitamin B12 and iron, which can affect overall health.
  • Intestinal Metaplasia: Changes in stomach cells considered a precancerous condition, especially in cases of long-standing H. pylori infection.
  • Gastric Perforation: A rupture of the stomach wall, a rare but serious complication.
  • Gastrointestinal Bleeding: May be chronic (causing anemia) or acute (requiring emergency treatment).
  • Gastric Ulcers: Deeper erosions of the stomach lining that can cause severe pain and bleeding.

Ongoing medical monitoring is essential to prevent these complications and ensure they are detected and treated promptly if they occur.

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How Do You Treat Gastritis?

Treatment for gastritis is personalized and depends on:

  • The underlying cause (e.g., H. pylori infection, NSAID use, autoimmune gastritis, stress).
  • The patient's overall health and medical conditions (including coexisting diseases and medication tolerance).
  • Response to initial treatment.
  • Severity and type of gastritis (acute vs. chronic).

The primary goals of treatment are to reduce inflammation, protect the stomach lining, promote healing, and address the underlying cause.

Pharmacological Treatment

Proton Pump Inhibitors (PPIs)

PPIs reduce stomach acid production, promoting healing of the gastric lining and relieving symptoms. They are among the most commonly prescribed medications for gastritis:

  • Omeprazole
  • Lansoprazole
  • Pantoprazole
  • Esomeprazole

They are used both for acute treatment and for long-term management in chronic cases.

Histamine H2 Receptor Antagonists

These medications reduce gastric acid secretion, although they are generally less potent than PPIs:

  • Famotidine
  • Ranitidine

Antacids

Antacids neutralize stomach acid and provide rapid but temporary symptom relief.

  • Magnesium-, aluminum-, and calcium-based compounds.
  • Useful for occasional symptomatic relief.

Helicobacter pylori Eradication Therapy

If H. pylori infection is confirmed, a triple or quadruple therapy regimen is prescribed (a combination of antibiotics plus a PPI, with or without bismuth). The goal is the complete eradication of the bacterium, which is essential for preventing recurrence and complications.

Common treatment regimens include:

  • PPI + amoxicillin + clarithromycin
  • PPI + amoxicillin + metronidazole + bismuth

Additional considerations:

  • Duration: typically 10–14 days.
  • Eradication testing: performed at least four weeks after completion of treatment to confirm success.

Gastric Mucosal Protective Agents

  • Sucralfate: forms a protective barrier over the stomach lining.
  • Misoprostol: helps protect the gastric mucosa from NSAID-related damage and may be prescribed alongside NSAIDs in high-risk patients.

Medication Management

  • Discontinuation or substitution of NSAIDs: Patients should consult their physician about stopping or replacing ibuprofen, aspirin, or other NSAIDs with alternative pain relievers such as acetaminophen (paracetamol) when appropriate.
  • If NSAID therapy is necessary, a PPI is often prescribed to protect the stomach lining.

Lifestyle Modifications

Lifestyle changes are essential and should be implemented alongside medical therapy.

Diet

  • Avoid irritating foods and beverages, including alcohol, coffee, tea, chocolate, citrus fruits, fatty foods, and highly spicy dishes.
  • Avoid eating late at night; allow at least 2–3 hours between the last meal and bedtime.
  • Eat slowly and chew food thoroughly.
  • Choose smaller, more frequent meals (5–6 per day) rather than large meals.
  • Prefer easily digestible foods such as broth, cereals, cooked vegetables, lean fish, and chicken.

Smoking Cessation

Smoking interferes with the healing process of the gastric mucosa and should be stopped whenever possible.

Reduce Alcohol Consumption

Alcohol intake should be significantly reduced or completely avoided during treatment.

Stress Management

Relaxation techniques, meditation, and regular moderate physical activity can help manage stress. Intense exercise immediately after meals should be avoided.

Adequate Sleep

Aim for at least 7–8 hours of sleep per night.

Monitoring and Follow-Up

  • Assessment of treatment response: The physician monitors symptom improvement over time.
  • H. pylori eradication testing: Performed at least four weeks after completing eradication therapy to confirm that treatment was successful.
  • Follow-up gastroscopy: In selected cases (severe gastritis, suspected malignancy, or poor response to treatment), endoscopy may be repeated after 6–8 weeks to evaluate healing of the gastric mucosa.
  • Periodic surveillance: Patients with chronic H. pylori infection, even after successful treatment, may require ongoing monitoring for potential complications.

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Reviewed August 2026.