Gastritis
Introduction
Gastritis is a term used to describe a group of conditions characterized by inflammation of the lining of your stomach. Commonly, the inflammation of gastritis results from infection with the same bacterium that causes most stomach ulcers. Yet other factors — including traumatic injury and regular use of certain pain relievers — also can contribute to gastritis.
Gastritis may occur suddenly (acute gastritis), or it can occur slowly over time (chronic gastritis). In spite of the many conditions associated with gastritis, the signs and symptoms of the disease are very similar: a burning pain in your upper abdomen and, occasionally, bloating, belching, nausea or vomiting.
In some cases, gastritis can lead to ulcers and an increased risk of stomach cancer. For most people, however, gastritis isn't serious and improves quickly with treatment.
Signs and symptoms
The signs and symptoms of gastritis include:
- A gnawing or burning ache or pain (indigestion) in your upper abdomen that may become either worse or better when you eat
- Nausea
- Vomiting
- Loss of appetite
- Belching or bloating
- A feeling of fullness in your upper abdomen after eating
- Weight loss
Occasionally, gastritis may cause stomach bleeding, but it's rarely severe. But be aware that bleeding in your stomach that causes you to vomit blood or pass black, tarry stools requires immediate medical care.
Causes
Gastritis usually develops when your stomach's protective layer becomes overwhelmed or damaged. A mucus-lined barrier protects the walls of your stomach from the acids that help digest your food. Weaknesses in the barrier allow your digestive juices to damage and inflame your stomach lining.
A number of factors can contribute to or trigger gastritis, including:
- Bacterial infection. People infected with Helicobacter pylori (H. pylori) can experience gastritis — most commonly chronic gastritis. Half the world's population is thought to be infected with the bacterium, which passes from person to person. But the majority of those infected don't experience any complications of H. pylori infection. In some people, H. pylori may break down the stomach's protective coating, causing changes in the stomach's lining. The reason why some people experience complications from H. pylori infection and others don't isn't clear. However, doctors believe vulnerability to the bacterium could be inherited from your parents or it could be caused by your lifestyle, such as smoking and high stress levels.
- Regular use of pain relievers. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil, Motrin, others) and naproxen (Aleve), can cause both acute gastritis and chronic gastritis. Using these drugs regularly or taking too much of these drugs may reduce a key substance that helps preserve the protective lining of your stomach. Stomach problems are less likely to develop if you take NSAIDs only occasionally.
- Excessive alcohol use. Alcohol can irritate and erode your stomach lining, which makes your stomach more vulnerable to digestive juices. Excessive alcohol use is more likely to cause acute gastritis.
- Stress. Severe stress due to major surgery, traumatic injury, burns or severe infections can cause acute gastritis.
- Bile reflux disease. Bile — a fluid that helps you digest fats — is produced in your liver and stored in your gallbladder. When it's released from the gallbladder, bile travels to your small intestine through a series of thin tubes. Normally, a ring-like sphincter muscle (pyloric valve) prevents bile from flowing into your stomach from your small intestine. But if this valve doesn't work properly, or if it has been removed because of surgery, bile can flow into your stomach, leading to inflammation and chronic gastritis.
- Your own body attacking cells in your stomach. Called autoimmune gastritis, this rare condition occurs when your body attacks the cells that make up your stomach lining. This produces a reaction by your immune system that can wear away at your stomach's protective barrier. Autoimmune gastritis is more common in people with autoimmune disorders, including Hashimoto's disease, Addison's disease and type 1 diabetes. Autoimmune gastritis can also be associated with vitamin B-12 deficiency, which can be harmful.
- Other diseases and conditions. Gastritis may be associated with other medical conditions, including HIV/AIDS, Crohn's disease, parasitic infections, some connective tissue disorders, and liver or kidney failure.
Treatment of gastritis depends on the specific cause. Acute gastritis caused by NSAIDs or alcohol may be relieved by stopping use of those substances. Chronic gastritis caused by H. pylori infection is treated by eradicating the bacteria. Most gastritis treatment plans also incorporate medications that treat stomach acid in order to reduce signs and symptoms you're experiencing and promote healing in your stomach.
Medications to treat stomach acid
Stomach acid irritates inflamed tissue in your stomach, causing pain and further inflammation. That's why, for most types of gastritis, treatment involves taking drugs to reduce or neutralize stomach acid, such as:
- Antacids. Over-the-counter antacids (Maalox, Mylanta, others) in liquid or tablet form are a common treatment for mild gastritis. Antacids neutralize stomach acid and can provide fast pain relief.
- Acid blockers. When antacids don't provide enough relief, your doctor may recommend a medication, such as cimetidine (Tagamet), ranitidine (Zantac), nizatidine (Axid) or famotidine (Pepcid), that helps reduce the amount of acid your stomach produces.
- Medications to shut down acid 'pumps.' Medications called proton pump inhibitors reduce acid by blocking the action of tiny pumps within the acid-secreting cells of your stomach. This class of medications includes omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex) and esomeprazole (Nexium).
Doctors use several regimens to treat H. Pylori infection. Most use a combination of two antibiotics and a proton pump inhibitor. Sometimes bismuth (Pepto-Bismol) is added to the mix. The antibiotics help destroy the bacteria, and the proton pump inhibitor relieves pain and nausea, heals inflammation and may increase the antibiotics' effectiveness.
To ensure that H. pylori has been eliminated, your doctor may test you again after treatment.
Prevention
Although you can't always prevent H. pylori infection, these suggestions can help reduce your risk of gastritis:
- Eat smart. If you experience frequent indigestion, eat smaller, more frequent meals to help ease the effects of stomach acid. In addition, avoid any foods you find irritating, especially those that are spicy, acidic, fried or fatty. While taking these steps can reduce the signs and symptoms you experience, they can't prevent gastritis.
- Limit or avoid alcohol. Excessive use of alcohol can irritate and erode the mucous lining of your stomach, causing inflammation and bleeding.
- Don't smoke. Smoking interferes with the protective lining of the stomach, making your stomach more susceptible to gastritis as well as ulcers. Smoking also increases stomach acid, delays stomach healing and is a leading risk factor for stomach cancer. Still, stopping isn't easy, especially if you've smoked for years. Talk to your doctor about methods that may help you stop smoking.
- Switch pain relievers. If possible, avoid taking NSAIDs — aspirin, ibuprofen and naproxen. These over-the-counter medications can cause stomach inflammation or make existing irritation worse. Instead, switch to pain relievers containing acetaminophen.
- Follow your doctor's recommendations. Your doctor may recommend that you take an over-the-counter antacid or acid blocker to help prevent recurring gastritis.
Credit: National Institute of Health.