Gastritis

National Digestive Diseases Information Clearinghouse

U.S. Department
of Health and
Human Services
NATIONAL
INSTITUTES
OF HEALTH
What is gastritis?
Gastritis is acondition inwhich thestomach
liningknownasthemucosaisinamed.
Thestomachliningcontainsspecialcellsthat
produceacidandenzymes,whichhelpbreak
downfoodfordigestion,andmucus,which
protectsthestomachliningfromacid. When
thestomachliningisinamed,itproduces
lessacid,enzymes,andmucus.
Gastritismaybeacuteorchronic. Sudden,
severeinammationofthestomachliningis
calledacutegastritis. Inammationthatlasts
for a longtime iscalledchronicgastritis. If
chronicgastritisisnottreated,itmaylastfor
yearsoreven alifetime.
Erosivegastritisisatypeofgastritisthat
oftendoesnotcausesignicantinammation
butcanwearawaythestomachlining. Ero-
sivegastritiscancausebleeding,erosions,
orulcers. Erosivegastritismaybeacuteor
chronic.
Therelationshipbetweengastritisand
symptomsisnotclear. Thetermgastritis
refersspecicallytoabnormalinamma-
tioninthestomachlining. Peoplewhohave
gastritismayexperiencepainordiscomfort
intheupperabdomen,butmanypeoplewith
gastritisdonothaveanysymptoms.
Thetermgastritisissometimesmistakenly
usedtodescribeanysymptomsofpainor
discomfortintheupperabdomen. Many
diseasesanddisorderscancausethesesymp-
toms. Mostpeoplewhohaveupperabdomi-
nalsymptomsdonothavegastritis.
What causes gastritis?
Helicobacter pylori (H. pylori) infectioncauses
mostcasesofchronicnonerosivegastritis.
H. pylori arebacteriathatinfectthestomach
lining. H. pylori areprimarilytransmitted
frompersontoperson. Inareaswithpoor
sanitation,H. pylori maybetransmitted
throughcontaminatedfoodorwater.
InindustrializedcountriesliketheUnited
States,20to50percentofthepopulation
maybeinfectedwithH. pylori.
1
Ratesof
H. pylori infectionarehigherinareaswith
poorsanitationandhigherpopulationden-
sity. Infectionratesmaybehigherthan
80percentinsomedevelopingcountries.
1
1
Lee Y,Liou J, Wu M, Wu C,Lin J. Review:
eradicationofHelicobacter pylori toprevent
gastroduodenaldiseases: hittingmorethanone
birdwiththesamestone. Therapeutic Advances in
Gastroenterology. 2008;1(2):111120.














































Themostcommoncauseoferosive
gastritisacuteandchronicisprolonged
useofnonsteroidalanti-inammatorydrugs
(NSAIDs)suchasaspirinandibuprofen.
Otheragentsthatcancauseerosivegastritis
includealcohol,cocaine,andradiation.
Traumaticinjuries,criticalillness,severe
burns,andmajorsurgerycanalsocause
acuteerosivegastritis. Thistypeofgastritis
iscalledstressgastritis.
Lesscommoncausesoferosiveandnonero-
sivegastritisinclude
autoimmunedisordersinwhichthe
immunesystemattackshealthycellsin
thestomachlining
somedigestivediseasesanddisorders,
suchasCrohnsdiseaseandpernicious
anemia
viruses,parasites,fungi,andbacteria
otherthanH. pylori
What are the symptoms of
gastritis?
Manypeoplewithgastritisdonothaveany
symptoms,butsomepeopleexperience
symptomssuchas
upperabdominaldiscomfortorpain
nausea
vomiting
Thesesymptomsarealsocalleddyspepsia.
Erosivegastritismaycauseulcersorerosions
inthestomachliningthatcanbleed. Signsof
bleedinginthestomachinclude
bloodinvomit
black,tarrystools
redbloodinthestool
What are the complications
of gastritis?
Mostformsofchronicnonspecicgastritis
donotcausesymptoms. However,chronic
gastritis is ariskfactor forpepticulcer
disease,gastricpolyps,andbenignand
malignantgastrictumors. Somepeoplewith
chronicH. pylori gastritisorautoimmune
gastritisdevelopatrophicgastritis. Atro-
phicgastritisdestroysthecellsinthestom-
achliningthatproducedigestiveacidsand
enzymes. Atrophicgastritiscanleadtotwo
typesofcancer: gastriccancerandgastric
mucosa-associatedlymphoidtissue(MALT)
lymphoma.
2 Gastritis

































































How is gastritis diagnosed?
Themostcommondiagnostictestforgastri-
tis isendoscopywith abiopsy of thestom-
ach. Thedoctorwillusuallygivethepatient
medicinetoreducediscomfortandanxiety
beforebeginningtheendoscopyprocedure.
Thedoctortheninsertsanendoscope,athin
tubewith atinycameraontheend,through
thepatientsmouthornoseandintothe
stomach. Thedoctorusestheendoscopeto
examinetheliningoftheesophagus,stom-
ach,andrstportionofthesmallintestine.
Ifnecessary,thedoctorwillusetheendo-
scopetoperform abiopsy,whichinvolves
collectingtinysamplesoftissueforexamina-
tionwithamicroscope.
Othertestsusedtoidentifythecauseof
gastritisoranycomplicationsincludethe
following:
Upper gastrointestinal (GI) series. The
patientswallowsbarium,aliquidcon-
trastmaterialthatmakesthedigestive
tractvisibleinanxray. X-rayimages
mayshowchangesinthestomachlining,
suchaserosionsorulcers.
Blood test. Thedoctormaycheckfor
anemia,aconditioninwhichthebloods
iron-richsubstance,hemoglobin,is
diminished. Anemia may be a sign of
chronicbleedinginthestomach.
Stool test. Thistestchecksforthepres-
enceofbloodinthestool,anothersign
ofbleedinginthestomach.
Tests for H. pylori infection. Thedoctor
maytest apatientsbreath,blood,or
stoolforsignsofinfection. H. pylori
infectioncanalsobeconrmedwith
biopsiestakenfromthestomachduring
endoscopy.
How is gastritis treated?
Medications that reduce the amount of acid
in the stomach can relieve symptoms that may
accompany gastritis and promote healing of the
stomach lining. These medications include
antacids,suchasAlka-Seltzer,
Maalox,Mylanta, Rolaids,andRio-
pan. Manybrandsonthemarket
usedifferentcombinationsofthree
basicsaltsmagnesium,calcium,and
aluminumwithhydroxideorbicarbon-
ateionstoneutralizetheacidinthe
stomach. Thesedrugsmayproduceside
effectssuchasdiarrheaorconstipation.
histamine 2 (H2)blockers,suchas
famotidine (Pepcid AC)andranitidine
(Zantac75). H2blockersdecreaseacid
production. Theyareavailableboth
overthecounterandbyprescription.
protonpumpinhibitors(PPIs),such
asomeprazole (Prilosec,Zegerid),
lansoprazole (Prevacid),pantoprazole
(Protonix),rabeprazole (Aciphex),
esomeprazole(Nexium),anddexlanso-
prazole(Kapidex). Allofthesedrugs
areavailable byprescription,andsome
arealsoavailableoverthecounter.
PPIsdecreaseacidproductionmore
effectivelythanH2blockers.
3 Gastritis





















































Dependingonthecauseofthegastritis,
additionalmeasuresortreatmentsmaybe
needed. Forexample,ifgastritisiscaused
byprolongeduse of NSAIDs, adoctor may
adviseapersontostoptakingNSAIDs,
reducethedoseofNSAIDs,orswitchto
anotherclassofmedicationsforpain. PPIs
maybeusedtopreventstressgastritisin
criticallyillpatients.
Treating H. pylori infectionsisimportant,
even if aperson isnotexperiencingsymp-
tomsfromtheinfection. UntreatedH. pylori
gastritismayleadtocancerorthedevelop-
mentofulcersinthestomachorsmallintes-
tine. Themostcommontreatment is a
tripletherapythatcombines aPPIand
twoantibioticsusuallyamoxicillinand
clarithromycintokillthebacteria. Treat-
mentmayalsoincludebismuthsubsalicylate
(Pepto-Bismol)tohelpkillbacteria.
Aftertreatment,thedoctormayuseabreath
orstooltesttomakesuretheH. pylori infec-
tionisgone. Curingtheinfectioncanbe
expectedtocurethegastritisanddecrease
theriskofothergastrointestinaldiseases
associatedwithgastritis,suchaspeptic
ulcerdisease,gastriccancer,andMALT
lymphoma.
Points to Remember
Gastritis is acondition inwhichthe
stomachliningisinamed.
Thetermgastritisrefersspecically
toabnormalinammationinthe
stomachlining. However,gastri-
tisissometimesmistakenlyused
todescribeanysymptomsofpain
ordiscomfortintheupperabdo-
men. Mostpeoplewhohaveupper
abdominalsymptomsdonothave
gastritis.
Themostcommoncausesofgas-
tritisareH. pylori infectionsand
prolongeduseofnonsteroidalanti-
inammatorydrugs(NSAIDs).
Manypeoplewithgastritishave
nosymptoms. Thosewhodo
havesymptomsmayexperience
dyspepsiaupperabdominal
discomfortorpain,nausea,or
vomiting.
Treating H. pylori infectionis
important,evenifapersonisnot
experiencingsymptoms. Left
untreated,H. pylori infectionmay
leadtopepticulcerdiseaseor
cancer.
4 Gastritis















































Hope through Research
TheNationalInstituteofDiabetesand
DigestiveandKidneyDiseases(NIDDK)
sponsorsresearchtoimprovetreatment
forpeoplewithdigestivedisorders,includ-
inggastritis. Researchersarestudyingthe
relationshipbetweenH. pylori infectionsand
gastriccancer.
Participants inclinicaltrialscanplay amore
activeroleintheirownhealthcare,gain
accesstonewresearchtreatmentsbefore
theyarewidelyavailable,andhelpothers by
contributingtomedicalresearch. Forinfor-
mationaboutcurrentstudies,visit
www.ClinicalTrials.gov.
For More Information
American College of Gastroenterology
P.O.Box342260
Bethesda,MD 208272260
Phone: 3012639000
Internet: www.acg.gi.org
American Gastroenterological Association
4930Del Ray Avenue
Bethesda,MD 20814
Phone: 3016542055
Fax: 3016545920
Email: member@gastro.org
Internet: www.gastro.org
Acknowledgments
Publicationsproduced bytheClearinghouse
arecarefullyreviewedbybothNIDDKsci-
entistsandoutsideexperts. Thispublication
wasreviewed byLindsayJones,M.D.,and
Brooks D.Cash,M.D., F.A.C.P., F.A.C.G.,
NationalNavalMedicalCenter.
You may alsond additional information about this
topic by visiting MedlinePlus at www.medlineplus.gov.
This publication may contain informationabout
medications. When prepared, this publication
included the most current information available.
For updatesor for questions about any medications,
contact the U.S. Food and Drug Administration
toll-free at 1888INFOFDA (18884636332) or
visitwww.fda.gov. Consult your doctor for more
information.
The U.S. Government does not endorse or favor any
speciccommercial product or company. Trade,
proprietary,or company namesappearing in this
document areused only because they are considered
necessary in thecontext of the information provided.
If a product isnot mentioned, theomission doesnot
mean or imply that the product isunsatisfactory.
5 Gastritis






























National Digestive Diseases
Information Clearinghouse
2 Information Way
Bethesda,MD 208923570
Phone: 18008915389
TTY: 18665691162
Fax: 7037384929
Email: nddic@info.niddk.nih.gov
Internet: www.digestive.niddk.nih.gov
TheNationalDigestiveDiseasesInformation
Clearinghouse(NDDIC) is aservice of the
NationalInstituteofDiabetesandDigestive
andKidneyDiseases(NIDDK). The
NIDDKispartoftheNationalInstitutesof
HealthoftheU.S.DepartmentofHealth
andHumanServices. Establishedin1980,
theClearinghouseprovidesinformation
aboutdigestivediseasestopeoplewith
digestivedisordersandtotheirfamilies,
healthcareprofessionals,andthepublic.
TheNDDICanswersinquiries,developsand
distributespublications,andworksclosely
withprofessionalandpatientorganizations
andGovernmentagenciestocoordinate
resourcesaboutdigestivediseases.
This publication is not copyrighted. The Clearinghouse
encourages users of this publication to duplicate and
distribute as many copies as desired.
This publication is available at
www.digestive.niddk.nih.gov.
U.S. DEPARTMENT OF HEALTH
AND HUMAN SERVICES
National Institutes of Health
NIHPublicationNo.104764
January2010
The NIDDK prints on recycled paper with bio-based ink.