Introduction

The membranes lining the stomach wall protect it from acid and germs. If this protective lining is irritated or damaged, it can become inflamed. Long-lasting inflammations can further damage the stomach lining and lead to stomach (gastric) ulcers.

Inflammation of the stomach lining is called gastritis. It's usually caused by certain bacteria or the regular use of anti-inflammatory painkillers.

There are two kinds of gastritis: acute and chronic. Acute gastritis is typically accompanied by very noticeable stomach and bowel problems that usually go away again on their own after a few days. Chronic gastritis, on the other hand, may go unnoticed. Sometimes it's not discovered until stomach ulcers have developed, which then cause noticeable symptoms.

Symptoms

The symptoms of acute gastritis include the following:

• Stomach pain
• Feeling full
• Heartburn
• Nausea and sometimes vomiting
• Belching
• Lack of appetite
• A bloated stomach

Some of these symptoms may also be signs of other conditions like gastro-esophageal reflux disease (GERD), an irritable stomach or bowel, and Diarrhea (gastroenteritis).

People with chronic gastritis often only have mild symptoms, or none at all. But they may have symptoms like those associated with acute gastritis.

Causes

Common causes of gastritis include an infection with Helicobacter pylori bacteria and taking anti-inflammatory painkillers known as NSAIDs.

Helicobacter pylori bacteria

Helicobacter bacteria upset the balance of stomach acid production. As a result, too much acid is made. This can damage the lining and wall of the stomach. But Helicobacter infections only rarely lead to gastritis: Although an estimated 40 out of 100 people in Germany have Helicobacter pylori in their stomach, only about 4 to 8 of them develop gastritis or a peptic (stomach or duodenal) ulcer.

The bacteria can be spread through saliva (spit), vomit, stool, drinking water or food. It is thought that most people already become infected in childhood, through close contact with family members.

Non-steroidal anti-inflammatory drugs (NSAIDs)

This group of drugs includes acetylsalicylic acid (the drug in medicines like Aspirin), diclofenac, ibuprofen and naproxen. Side effects are rare when these painkillers are taken for only a short time to treat acute pain. But if they are used for a longer time – such as several weeks or months – they may affect the protective function of the stomach lining because they block the production of the hormone prostaglandin. One of the things prostaglandin does is regulate the production of gastric (stomach) mucus and substances that neutralize stomach acid. If there's not enough prostaglandin, the stomach wall no longer has enough protection against stomach acid.

Combining painkillers with steroids can make this damaging effect worse.

Other causes

Smoking, long-term stress and certain kinds of foods (like fatty, sugary or spicy dishes) may also cause stomach problems. Drinking too much alcohol can lead to acute gastritis too.

Another, less common, cause of gastritis is a condition called bile reflux. This is where bile flows upward out of the small intestine and into the stomach, where it damages the lining.

Prevalence

Gastritis is common in Germany. It is estimated that 20 out of 100 people have acute gastritis at some point in their lives. Most women get gastritis between the ages of 45 and 64, and most men develop it over the age of 65. The risk of gastritis generally increases with age.

Effects

If the lining of the stomach or bowel no longer provide enough protection, their walls may become inflamed or damaged. An ulcer may develop in the stomach or duodenum as a result. The duodenum is the first part of the small intestine, just after the stomach. Gastric (stomach) ulcers and duodenal ulcers can lead to serious complications like bleeding.

If gastritis becomes chronic and the membrane lining is always inflamed, you might become anemic too. Cancerous tumors may develop, but that is very rare.

Diagnosis

To find out what is causing the symptoms, the doctor will first feel your stomach and upper abdomen area. Depending on the type of symptoms, your stomach might also be examined from the inside to find out more. This examination takes five to ten minutes. It is done using an instrument called a gastroscope which is gently inserted into your stomach through your mouth and food pipe. Doctors can use the gastroscope camera to look at the walls of your food pipe (esophagus), stomach and duodenum. In this way, they can find changes such as inflammation or bleeding in the stomach lining. They can also use the gastroscope to take some tissue from the lining and then have the sample checked for Helicobacter pylori bacteria or cell changes such as cancer. 

Sometimes a special breath test is done to confirm the presence of a Helicobacter pylori infection. These bacteria can also be detected using a blood test or stool test.

Treatment

If you notice that certain foods, stress, alcohol or nicotine make the stomach problems worse, you can try changing your diet, avoiding alcohol, quitting smoking and/or reducing stress in your daily life. If these lifestyle changes are not enough to relieve the symptoms, medication is considered.

Gastritis is typically treated with acid-lowering medication. Depending on the type and severity of the symptoms, the following drugs can be used:

• Proton pump inhibitors (PPIs) like omeprazole or pantoprazole reduce the production of stomach acid.
• H2 blockers such as ranitidine and famotidine also reduce acid production.
• Antacids like aluminium hydroxide or magnesium hydroxide neutralize the acid already in your stomach.

If the gastritis is caused by a Helicobacter infection, proton pump inhibitors are combined with two or three antibiotics.

If it's caused by a painkiller, you can consult your doctor about switching to a different medication or combining the painkiller with an acid-lowering drug. Should an NSAID have to be taken regularly, it's possible to take it along with acid-lowering medication from the start, as a precaution.

Further information

When people are ill or need medical advice, they usually go to see their family doctor first. Read about how to find the right doctor, how to prepare for the appointment and what to remember.

Sources

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• Fischbach W, Malfertheiner P, Lynen Jansen P, Bolten W, Bornschein J, Buderus S et al. S2k-Leitlinie Helicobacter pylori und gastroduodenale Ulkuskrankheit. AWMF-Registernr.: 021-001. Z Gastroenterol 2016; 54: 327-363. [PubMed: 27512738]
• Hawkey CJ, Langman MJ. Non-steroidal anti-inflammatory drugs: overall risks and management. Complementary roles for COX-2 inhibitors and proton pump inhibitors. Gut 2003; 52(4): 600-608. [PMC free article: PMC1773617] [PubMed: 12631678]
• Levenstein S, Rosenstock S, Jacobsen RK, Jorgensen T. Psychological stress increases risk for peptic ulcer, regardless of Helicobacter pylori infection or use of nonsteroidal anti-inflammatory drugs. Clin Gastroenterol Hepatol 2015; 13(3): 498-506. [PubMed: 25111233]
• Malfertheiner P, Megraud F, O'Morain CA, Atherton J, Axon AT, Bazzoli F et al. Management of Helicobacter pylori infection - the Maastricht IV / Florence Consensus Report. Gut 2012; 61(5): 646-664. [PubMed: 22491499]
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• Robert Koch-Institut (RKI), Statistisches Bundesamt (Destatis). Gastritis, Magen- und Zwölffingerdarmgeschwüre. Berlin: RKI; 2013. (Gesundheitsberichterstattung des Bundes; Heft 55).
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