Gastritis

Gastritis occurs when the stomach's mucosal barrier is compromised. The most frequent cause is infection with Helicobacter pylori, a bacterium that colonizes the stomach lining and induces a chronic inflammatory response. According to research published in The Lancet Infectious Diseases (2023), H. pylori utilizes an enzyme called urease to neutralize stomach acid, allowing it to survive and damage the protective mucus layer.

Non-Modifiable Risk Factors

• Age: Older adults have a higher risk because the stomach lining tends to thin with age and they are more likely to have H. pylori or autoimmune disorders.
• Genetics: Some individuals have a genetic predisposition to autoimmune gastritis or a higher susceptibility to bacterial colonization.
• Autoimmune Disorders: Conditions like Type 1 diabetes or Hashimoto's disease increase the risk of autoimmune gastritis.

Modifiable Risk Factors

• Medication Use: Regular use of NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) inhibits prostaglandins, which are chemicals that help maintain the stomach's protective lining.
• Alcohol Consumption: Excessive alcohol can irritate and erode the stomach lining.
• Smoking: Smoking interferes with the protective lining and slows the healing process.
• Extreme Stress: Major surgery, severe burns, or critical infections can cause 'stress gastritis' due to reduced blood flow to the stomach.

Populations in developing nations have a higher prevalence of H. pylori-induced gastritis due to water sanitation factors. In the United States, the CDC (2024) notes that the risk is higher in socioeconomically disadvantaged areas and among those with chronic pain conditions requiring daily NSAID therapy.

Prevention strategies focus on mitigating known irritants. Evidence-based recommendations include practicing good hand hygiene to prevent H. pylori transmission, limiting the use of over-the-counter pain relievers, and moderating alcohol intake. For those required to take long-term NSAIDs, healthcare providers may recommend co-therapy with protective agents.

The diagnostic journey typically begins with a clinical history and physical examination. A healthcare provider will look for 'epigastric tenderness' (pain when pressing on the upper abdomen) and review the patient's medication history and lifestyle habits.

During the exam, the doctor may check for signs of anemia (such as pale skin or a rapid heartbeat) and palpate the abdomen to rule out other causes of pain, such as an enlarged gallbladder or liver.

• H. pylori Testing: This can be performed via a Urea Breath Test (where the patient drinks a liquid and breathes into a bag), a stool antigen test, or a blood antibody test.
• Upper Endoscopy (EGD): A thin, flexible tube with a camera is inserted through the mouth into the stomach. This allows the doctor to visually inspect the lining for inflammation or erosions.
• Biopsy: During an endoscopy, small tissue samples are often taken to be examined under a microscope for inflammatory cells or cancerous changes.
• Upper GI Series: An X-ray procedure where the patient swallows barium (a contrast liquid) to make the stomach lining visible on imaging.

Clinical diagnosis is confirmed when histological (microscopic) evidence shows inflammatory cell infiltration in the gastric mucosa. For autoimmune gastritis, lab values showing low Vitamin B12 levels and the presence of anti-parietal cell antibodies are diagnostic.

Healthcare providers must rule out conditions that mimic gastritis, including:

• Peptic Ulcer Disease: Open sores in the stomach or duodenum.
• GERD: Acid reflux into the esophagus.
• Gastroenteritis: A viral or bacterial 'stomach flu' affecting the intestines.
• Gallstones: Pain usually located in the upper right quadrant.

The primary goals of gastritis treatment are to eliminate the underlying cause (such as bacteria or irritants), reduce the acidity of the stomach to allow the lining to heal, and manage symptoms to improve quality of life.

According to the American College of Gastroenterology (ACG) guidelines, the standard first-line approach depends on the cause. If H. pylori is present, 'Eradication Therapy' is mandatory. If the cause is medication-related, the primary step is the cessation or reduction of the offending agent under medical supervision.

• Proton Pump Inhibitors (PPIs): These work by blocking the 'pumps' in the stomach cells that produce acid. They are highly effective at allowing the mucosa to heal. Common side effects may include headache or digestive upset with long-term use.
• H2 Blockers (Histamine H2-receptor antagonists): These reduce the amount of acid released into the digestive tract, providing relief from pain and inflammation. They are often preferred for milder cases.
• Antacids: These neutralize existing stomach acid for rapid, short-term symptom relief. They do not heal the underlying inflammation but are useful for breakthrough pain.
• Cytoprotective Agents: These medications help coat the stomach lining and protect it while it heals.
• Antibiotics: Used specifically in 'combination therapy' to kill H. pylori bacteria. Usually, two or more different classes are used simultaneously to prevent bacterial resistance.

If the initial treatment fails to eradicate H. pylori, healthcare providers may use 'Quadruple Therapy,' which involves a combination of a PPI, bismuth subsalicylate, and two different types of antibiotics.

In cases of severe erosive gastritis with bleeding, endoscopic procedures may be required to cauterize (seal) bleeding vessels. Surgery is rarely needed for gastritis unless complications like a perforation occur.

Acute gastritis may resolve within a few weeks of treatment. Chronic gastritis requires longer management, often 4 to 8 weeks of acid suppression. Follow-up testing (especially for H. pylori) is typically conducted 4 weeks after treatment ends to ensure success.

In the elderly, PPIs must be used with caution due to the risk of bone fractures and nutrient malabsorption. During pregnancy, many acid-suppressing medications are considered safe, but a healthcare provider must be consulted to weigh the benefits and risks.

> Important: Talk to your healthcare provider about which approach is right for you.

Dietary management is a cornerstone of gastritis recovery. Research suggests that a 'Bland Diet' can reduce gastric irritation. Patients should focus on high-fiber foods (like whole grains and vegetables), low-fat proteins (like fish and lean poultry), and foods with low acidity. A study in the Journal of Clinical Biochemistry and Nutrition (2023) suggests that certain probiotics may help suppress H. pylori activity. Avoid 'triggers' such as spicy foods, highly acidic fruits (citrus), caffeine, and chocolate.

Moderate exercise is generally encouraged as it can improve digestive motility and reduce stress. However, high-intensity 'jarring' exercises (like long-distance running) may exacerbate symptoms in some patients. It is best to wait at least 2 hours after eating before engaging in vigorous activity.

Sleep hygiene is vital, as the body repairs tissue during rest. Patients with nocturnal acid reflux (often associated with gastritis) should consider elevating the head of their bed by 6 inches and avoiding food for 3 hours before sleep.

Physiological and psychological stress can increase gastric acid production. Evidence-based techniques such as diaphragmatic breathing, progressive muscle relaxation, and mindfulness-based stress reduction (MBSR) have been shown to help manage functional dyspepsia symptoms.

While not replacements for medical treatment, some patients find relief with ginger (for nausea) or chamomile tea. However, the evidence level for many herbal supplements remains low, and some can actually irritate the stomach further. Always consult a doctor before starting supplements.

Caregivers should help monitor the patient's adherence to medication and dietary restrictions. It is also important to watch for signs of worsening condition, such as increased fatigue or changes in stool color, and provide emotional support during flare-ups.

The prognosis for most forms of gastritis is excellent when the underlying cause is identified and treated. According to the NIDDK (2023), most people with acute gastritis recover fully without long-term complications once the irritant is removed. Chronic gastritis, while requiring more time, typically responds well to antibiotic and acid-suppression therapy.

If left untreated, chronic gastritis can lead to serious health issues:

• Peptic Ulcers: Deep sores that can cause internal bleeding.
• Gastric Polyps: Small growths on the stomach lining.
• Atrophic Gastritis: Chronic inflammation that leads to the loss of the stomach lining and its glands.
• Gastric Cancer: Chronic H. pylori infection and autoimmune gastritis are significant risk factors for stomach adenocarcinoma.

For those with chronic or autoimmune gastritis, long-term management may involve periodic endoscopic surveillance to monitor for precancerous changes. Patients with autoimmune gastritis will require lifelong Vitamin B12 supplementation.

Success involves maintaining a 'gastritis-friendly' lifestyle even after symptoms subside. This includes staying hydrated, eating smaller and more frequent meals, and maintaining an open dialogue with a gastroenterologist.

Contact your healthcare provider if symptoms persist despite treatment, if you experience significant weight loss, or if you develop new symptoms like difficulty swallowing.