In everyday life we talk about gastritis (inflammation of the stomach) or gastroenteritis when we eat something bad and we suffer from short digestive troubles including nausea and vomiting. However, the issue of gastritis is much more difficult. The inflammation of the gastric mucosa can have many causes and even its consequences can be different ranging from banal nausea to chronic digestive problems, anemia, or even extremely dangerous stomach cancer.


First, it is also necessary to emphasize that the medically correct diagnosis of gastritis can be done only on the basis of examination of gastric mucosa sample under the microscope (i.e. histological confirmation) and has nothing to do with the severity of symptoms.


Acute inflammations of the stomach are commonly associated with acute infections of the digestive tract (campylobacter, rotavirus, salmonella, etc.) or with an alcoholic excess. Alcohol is unfriendly to mucous membrane of the digestive tract and damages it. Short-time gastritis usually occurs during the hangover and together they cause temporary loss of appetite and stomach discomfort. Chronic alcoholics may suffer from chronic gastritis. Similar effect to alcohol has chronic usage of common non-steroidal anti-inflammatory drugs. Inflammatory changes in the mucosa may be also caused by return of digestive juices from the small intestine into the stomach.


Very frequently mentioned cause of chronic gastritis is the bacterium known as Helicobacter pylori. This bacterium lives in the stomach of a substantial part of the population. It usually does no harm, but in certain people (probably genetically predisposed), the bacterium can trigger a chronic inflammation of stomach and duodenum causing serious complications such as peptic ulcers and stomach cancer.


When listing the causes of gastritis, we must not forget the so-called autoimmune gastritis. This condition is caused when our own antibodies begin to attack the gastric mucosa. The autoimmune gastritis is tightly related to anemia due to vitamin B12 deficiency.


The symptoms may be very variable. Acute gastritis usually manifests with pain in the upper abdomen, loss of appetite and vomiting. Slightly elevated temperature may or may not be present. Chronic long-lasting gastritis is much more insidious. It may be asymptomatic or cause gradual weight loss, iron deficiency anemia (by chronic microscopic bleeding) or anemia due to malabsorption of vitamin B12 (pernicious anemia). Chronic irritation of gastric mucosa may cause development of peptic ulcers or even stomach cancer. This is due to the fact that persistent irritation of the mucous membranes causes histological changes in the mucosa (intestinal metaplasia professionally) and these changes may slowly progress into malignant disease.


Patients with acute and short-term difficulties are usually not strained with complicated examination procedures, but we should surely further examine any chronic digestive troubles. The most ideal examination is the upper GI endoscopy. It allows us to see the entire gastric and duodenal mucosa where we can confirm suspected macroscopic signs of inflammation (mucosal congestion, redness, swelling of the mucous membranes, signs of minor bleeding, ulcers, etc.). However, the diagnosis of gastritis must be confirmed by taking a sample of stomach mucosa and its histological examination with positive confirmation of inflammatory changes. In addition, the endoscopy allows us to easily diagnose presence of Helicobacter pylori.


The therapy depends on the actual cause of inflammation. If we are able, we should remove the underlying cause (see above) such as irritating medications, alcohol or Helicobacter pylori. Helicobacter pylori is treated by combination of antibiotics and proton pump inhibitors. There are many therapeutic schemes, but the indications when treat and when do not, is still disputed by gastroenterologists.


When the chronic inflammation causes vitamin B12 deficiency, we can supplement in, usually in form of injections.


People with chronic atrophic gastritis resulting from Helicobacter infection or from autoimmune disease should be regularly endoscopically checked with taking biopsy samples. When a biopsy finds precancerous changes in the mucosa, it is advisable to think about preventive gastrectomy.


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources