Gastritis Overview
Gastritis, an inflammation or irritation of the lining of the stomach, is not a single disease. Rather, gastritis is a condition that has many causes. Common to all people with gastritis is pain or discomfort in the upper part of the abdomen, sometimes called dyspepsia. Gastritis can be a brief and sudden illness (acute gastritis), a longer-lasting condition (chronic gastritis), or a special condition, perhaps as part of another medical illness. An example of acute gastritis is stomach upset that may follow the use of alcohol or aspirin. Helicobacter pylori is a type of bacteria that infects the stomach. Infection with this bacteria may lead to chronic gastritis. Gastritis is a common medical problem. Up to 10% of people who come to a hospital emergency department with abdominal pain have gastritis.

Gastritis Causes Gastritis is associated with various medications, medical and surgical conditions, physical stresses, social habits, chemicals, and infections. Some of the more common causes of gastritis are listed here.

Medications Aspirin (more than 300 drug products contain some form of aspirin) Nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen or naproxen) Steroids (prednisone is one example) Potassium supplements Iron tablets Cancer chemotherapy medications Swallowing poisons or objects Corrosives (acid or lye) Alcohols of various types Swallowed foreign bodies (paper clips or pins)

Medical and surgical conditions Physical stress in people who are critically ill or injured After medical procedures (such as endoscopy, in which a specialist looks into the stomach with a small lighted tube) After an operation to remove part of the stomach After radiation treatment for cancer Autoimmune diseases Pernicious anemia Chronic vomiting Infections Tuberculosis Syphilis Bacterial infections: H pylori infection is the most common. Many other bacteria-even those that usually cause pneumonia or bladder infections-can cause gastritis. Viral infections Fungal (yeast) infections Parasites and worms Gastritis

Symptoms Symptoms of gastritis do not always correspond to the extent of physical changes in the lining of the stomach. The stomach lining can be examined with an endoscope, a thin probe with a tiny camera on the end that can be inserted into the stomach. Severe gastritis may be present when the stomach is viewed without symptoms being present. Severe gastritis symptoms may be present despite only minor changes in the stomach lining. Elderly people in particular have a much higher likelihood of developing painless stomach damage. They may have no symptoms at all (no nausea, vomiting, pain) until they are suddenly taken ill with internal bleeding. In people who have gastritis symptoms, pain or discomfort in the upper abdomen is the most common. The pain is usually in the upper central portion of the abdomen Gastritis pain occurs in the left upper portion of the abdomen and in the back. The pain seems to go right straight through a person as it travels from the belly to the back. People often use the terms burning, aching, gnawing, or sore to describe the pain. Usually, a vague sense of discomfort is present, but the pain may be sharp, stabbing, or cutting. Other symptoms of gastritis include the following: Belching: Belching usually either does not relieve the pain or relieves it only briefly. Nausea and vomiting: The vomit may be clear, green or yellow, blood-streaked, or completely bloody, depending on the severity of the stomach inflammation. Bloating Feeling of fullness or burning in the upper part of the belly In more severe gastritis, bleeding may occur inside the stomach. Any of the following symptoms can be seen as well as those already mentioned. Pallor, sweating, and rapid (or racing) heart beat. Feeling faint or short of breath Chest pain or severe stomach pain Vomiting large amounts of blood Bloody bowel movements or dark, sticky, very foul-smelling bowel movements.

When to Seek Medical Care See your health care provider if your symptoms are new, long-lasting, or worsening despite self-care. Seek immediate medical attention if you have any of the following symptoms. Your decision to call 911 or to seek medical care will be based on your judgment of how sick you feel. Vomiting that does not allow you to take food, fluids, and medications Fever with abdominal pain Fainting or feeling faint Rapid heartbeat Unexplained sweating Pallor Repeated vomiting of green or yellow material Vomiting any amount of blood Shortness of breath Chest pain Exams and Tests The health care provider first interviews you about your symptoms, medical history, habits and lifestyle, and the medications you take. This information is enough to make the diagnosis in many people. Be sure to tell him or her about all the medications you take, including nonprescription drugs, herbal and botanical preparations, and supplements such as vitamins. Also report any measures you have taken to relieve the symptoms and how well those measures worked. Laboratory testing: No laboratory tests can pinpoint a diagnosis of gastritis. Often, no tests are necessary. If your health care provider orders tests, it is probably to rule out certain medical conditions. If all other possibilities are ruled out, that leaves gastritis as the most likely cause of your symptoms. The following tests are most likely to be ordered: Blood cell counts (looking mostly for anemia, a low blood count) Liver and kidney functions Urinalysis Gallbladder and pancreas functions Pregnancy test H pylori tests Stool, for blood X-rays films or other diagnostic images may be ordered, although they are usually not necessary. An ECG (a heart wave tracing) is usually performed if your heartbeat is rapid or you are having chest pain. You may be referred to a gastroenterologist, a doctor who specializes in diseases of the digestive system. The gastroenterologist may in turn recommend an endoscopy. During the endoscopy, a thin, flexible probe with a tiny camera on the end is sent into your stomach for a direct look. At the same time, samples of your stomach lining can be taken to test for a wide variety of conditions.

Gastritis Treatment Once the diagnosis of gastritis has been confirmed by a medical professional, treatment can begin. The choice of treatment depends to some extent on the cause of the gastritis. Some treatments target the exact cause of a particular type of gastritis. Most treatments aim at reducing symptoms. Your stomach often will heal over time if it is protected.

Self-Care at Home If you know what causes your gastritis, the simplest way to avoid the disease is to avoid the cause. Aspirin and alcohol are 2 widely used substances that cause gastritis. If you develop an upset stomach and nausea after drinking alcohol or using aspirin, then avoid these substances. Sometimes you cannot avoid certain substances that cause gastritis. Your health care provider may have a good reason to recommend aspirin, iron, potassium, or some other medication that causes gastritis. If you develop minor gastritis symptoms, it may be wisest to continue the recommended medication and treat the gastritis symptoms. Consult your health care provider before stopping any medication. In the case of aspirin, coated aspirin may not cause the same symptoms. This is because coated aspirin does not dissolve in the stomach. Check the contents of any other over-the-counter medication you are taking because more than 300 medications contain aspirin in some form. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen also cause gastritis. Your health care provider may recommend that these medications be taken with food or with antacids. Doing this may lessen the chance of developing gastritis symptoms. Switching from aspirin or NSAIDs to another pain reliever may help as well. Acetaminophen is not known to cause gastritis. Talk with your health care provider before simply switching to acetaminophen, however. He or she may have recommended aspirin or an NSAID for a specific purpose. Acetaminophen and aspirin are both pain relievers, but they are different medications. If gastritis symptoms continue, antacids are sometimes recommended. Three main types of antacids are available. All 3 are about equal in effectiveness. Magnesium-containing antacids may cause diarrhea. People with certain kidney problems should use these cautiously or not at all. Aluminum-containing antacids can cause constipation. Calcium-containing antacids have received a great deal of attention for their ability to control stomach acid and also supplement body calcium. Calcium supplementation is most important for postmenopausal women. Calcium-based antacids can also lead to constipation, however. Antacids may also change your body`s ability to absorb certain other medications. If you require an antacid more than occasionally, let your health care provider decide which one is best for you. Histamine (H2) blockers have received a lot of attention for stomach problems. Some of these medications-cimetidine (Tagamet) and ranitidine are 2 examples-are available without a prescription. Histamine blockers work by reducing acid secretion in the stomach. This reduces gastritis pain and other symptoms. If you need one of these medications regularly, you should consult your health care provider for a recommendation. Stronger medications that protect the stomach`s lining or lessen acid production in the stomach are available by prescription. Talk to your health care provider if the nonprescription medications do not work for you.

Medical Treatment The safest treatment is to avoid substances that trigger gastritis symptoms. Almost all health care providers would recommend this as the first step in preventing gastritis. First, you have to identify what these triggers are for you. Most people are fairly aware of their triggers before seeking medical care. If you do not know your triggers, your health care provider can help you figure them out. Common avoidable triggers of gastritis symptoms include the following. See Causes for a more complete list. Certain medications and poisons Cigarette smoking Alcohol Coffee and other beverages that contain caffeine, such as cola and tea

Medications Histamine (H2) blockers: Four histamine blockers are available in the United States. Some are available without a prescription; others require a prescription. All work by blocking the release of acid from specialized glands in your stomach. The idea is that producing less acid allows your stomach to heal. Once healed, the previously inflamed stomach then causes no further symptoms. Commonly prescribed H2-blockers include cimetidine, famotidine, nizatidine, and ranitidine. Proton pump inhibitors (PPIs): These medications are very powerful blockers of the stomach`s ability to secrete acid. A health care provider who prescribes one of these medications to treat your gastritis may be doing so in consultation with a gastroenterologist. These medications include lansoprazole and omeprazole. Coating agents: These medications protect the stomach`s lining. Sucralfate - Coats and protects the stomach lining Misoprostol - Also protects the stomach lining, used as a preventive measure for people taking NSAIDs who are at high risk for developing stomach damage Antibiotics: An antibiotic may be prescribed if H pylori is demonstrated to be the cause of your gastritis. Antiemetics: These medications help control nausea and vomiting. A number of different antiemetics can be used in the emergency department to control those symptoms. Some these medications are available by prescription for home use as well.

Follow-up In general, follow-up care for gastritis is very straightforward. Avoid those things that irritate your stomach or cause your symptoms to flare up. Take your medications as prescribed by your health care provider. Return for medical attention if your symptoms worsen or persist. Report any new symptoms to your health care provider.

Prevention The mainstay of gastritis prevention is to avoid those things that irritate or inflame your stomach`s lining. Aspirin (use coated aspirin if you must take aspirin) NSAIDs such as ibuprofen (Motrin, Advil) or naproxen Smoking Caffeine and other caffeinelike substances Alcohol If your health care provider has prescribed a medication that you think is causing gastritis symptoms, talk to him or her before you stop taking the medication. The medication may be very important for your health. Outlook Most people recover from gastritis. Depending on the many factors that affect your stomach lining, gastritis symptoms may flare up from time to time. Overall, gastritis is generally a common, mildly troubling ailment that responds well to simple treatments. On occasion, rare forms of gastritis can be serious or even life threatening. Severe, ongoing symptoms or internal bleeding should alert your health care provider to search for a more serious underlying cause.