What is Chronic Gastritis?

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Chronic gastritis is a long-term condition in which the mucus-lined layer of the stomach, also known as the gastric mucosa, is inflamed or irritated over a longer period of time. Symptoms tend to appear slowly, over time.

Some of the causes of chronic gastritis include:^[1][2][3]

• Infection with bacteria of the helicobacter pylori species (H. pylori). This cause is by far the most common and is sometimes referred to as Type B gastritis.
• Damage to the stomach lining, such as that caused by chemical irritation from substances including alcohol, certain painkillers such as nonsteroidal anti-inflammatory drugs (NSAIDs) or bile entering the stomach.
• A malfunction of the immune system, making it an autoimmune disorder. This is sometimes referred to as Type A gastritis and is the least common cause of chronic gastritis

Depending on the underlying cause, chronic gastritis can generally be treated relatively simply.
Chronic gastritis often improves quickly once treatment has begun.

Without treatment, chronic gastritis can progress over a number of months to years to the point where the stomach lining is so damaged that the affected person is at risk of:

• Peptic ulcers
• Gastric polyps or tumors that may be non-cancerous
• Anemia, more commonly in cases of autoimmune gastritis

Even though the risk remains low, people with untreated chronic gastritis are also at a higher risk than the general population of developing cancerous tumors of the stomach.

Chronic vs. acute gastritis

Acute gastritis is also an inflammation or irritation of the stomach lining, but one that lasts for a shorter period of time than chronic gastritis. A person affected by chronic gastritis may sometimes not notice many or possibly not even any symptoms and when pain appears, it is typically dull and long-lasting. Acute gastritis tends to set in more quickly, with pain often felt more sharply.^[4]

Read more about Acute Gastritis »

Gastritis vs. gastroenteritis

Both acute and chronic gastritis directly affect the stomach and may cause nausea and vomiting. Gastroenteritis affects the intestines, as well as the stomach. While nausea and vomiting often result from gastroenteritis, it also very likely leads to diarrhea, which is not a symptom of gastritis.

Read more about Gastroenteritis »

Chronic gastritis symptoms

A lot of people infected with H. Pylori, which is the main cause of chronic gastritis, do not develop any symptoms for a long time and experience no complications.^[2]

People who experience symptoms linked to chronic gastritis, rather than its various complications, may experience:^[5]

• Pain or an ache in the upper abdomen
• A feeling of being full
• Pain while fasting
• Pain after eating
• Nausea
• Vomiting

Worried you may have this condition?, check your conditions Adoctor conditions.

Symptoms of type A autoimmune chronic gastritis

Pain may not be in the foreground in people with autoimmune chronic gastritis and most will not experience pain as strongly as those with chronic gastritis caused by H. pylori or NSAIDs.^[6][7]

Some people with autoimmune chronic gastritis may experience a full feeling in the upper abdomen after eating, feel nauseous or vomit. ^[7]

The main resulting condition from autoimmune chronic gastritis is pernicious anemia, caused by a lack of vitamin B12, due to problems with vitamin B12 absorption due to the effects of the gastritis. It may also lead to iron deficiency anemia or other conditions, though.^[6][8][7]

Symptoms of pernicious anemia may include:^[8][9][10]

• Diarrhea
• Feeling dizzy or clumsy
• Feeling tired
• Shortness of breath, especially when exercising
• Brittle nails and dry skin
• Numbness or pins and needles
• Abnormalities in gait
• Reduced taste and smell
• Lack of concentration
• Psychiatric or cognitive symptoms

Symptoms of iron deficiency anemia may include:^[11][12]

• Feeling tired
• Pale skin
• Headaches
• Brittle nails and dry skin
• Shortness of breath
• Heart palpitations
• Tinnitus

Read more about Anemia ».

Chronic gastritis complications

Chronic gastritis can lead to other conditions if not properly managed. As chronic gastritis may often be asymptomatic, another condition may be the first sign that a person is affected by chronic gastritis. If any of these symptoms seem familiar, Contact a professional, don’t play with your health doctor’s location. Some of these complications include:

Stomach ulcers

A stomach ulcer is a sore in the lining of the stomach, caused by damage to the stomach lining due to prolonged exposure to gastric acid. Eight out of 10 stomach ulcers, also known as peptic ulcers, are linked to infection with H. pylori. Long-term use of NSAID painkillers is another cause.

Symptoms of a stomach ulcer include:^[13][14][15]

• Burning pain in the stomach
• Nausea and retching
• Vomiting
• Bloating or feeling full
• Belching
• Heartburn
• Changes in appetite
• Unexplained weight loss
• Difficulty breathing
• Feeling faint
• Vomiting blood
• Blood in stools
• Stools that appear black or tarry

These symptoms usually:^[14][16]

• Appear on an empty stomach
• Last for minutes or possibly hours
• Appear on and off over several weeks
• Can be stopped for a short time by taking antacids

Read more about Peptic Ulcer Disease »

Atrophic gastritis

If left untreated, severe chronic gastritis, especially Type A autoimmune chronic gastritis, as well as Type B H. pylori chronic gastritis can develop into atrophic gastritis. This is where the protective mucus layer in the stomach is damaged, leading to the loss of gastric glandular cells, which is compensated by cells usually found in the intestine. Eventually, gastric glandular cells are replaced by intestinal and fibrous tissue. This process is known as intestinal metaplasia (IM) of the stomach, and those affected are at increased risk of gastric cancer compared to the general population, although the overall risk remains relatively low.^{[17][18][2][19]}

Atrophic gastritis is the development of chronic gastritis and the symptoms depend on the specific cause of the condition.For example, atrophic gastritis if due to chronic gastritis caused by H. pylori bacteria may often not cause many, possibly not even any symptoms. Whereas a person with autoimmune chronic gastritis that develops into atrophic gastritis may display symptoms of pernicious (related to vitamin B12) or iron-deficiency anemia. See the section above on symptoms to see more signs of chronic gastritis.

Gastric polyps or tumors

Gastric polyps are growths that form in the lining of the stomach. They do not usually cause symptoms, but when they do, these can include:^[20][21]

• Anemia
• Tender stomach when pressed
• In rarer cases, bleeding

Most gastric polyps are benign, meaning non-cancerous, but some can develop into gastric cancers.^[22]

Seeking medical advice from a doctor is advisable if any of the symptoms of chronic or acute gastritis are experienced.

Good to know: The chance of developing cancer from gastritis or atrophic gastritis is low. However, a gastric cancer screening is recommended for people diagnosed with atrophic gastritis at regular intervals. These gaps between screenings will likely be between everyone and three years depending on a doctor’s recommendations.^[23][24][25]

Other effective ways of lowering the chances of gastric cancer include:^[26][27]

• A diet high in fresh fruit and vegetables
• A diet low in highly processed foods containing lots of salt (sodium) and hydrogenated fats
• Avoiding red meats, especially processed, smoked ones containing high levels of nitrate salts and/or nitrite
• Leading a smoke and nicotine free lifestyle
• Drinking alcohol only in moderate amounts

Chronic gastritis causes

If the protective layer of mucus in the stomach is damaged, gastric acids can irritate the stomach lining underneath the mucus.

In the great majority of cases, chronic gastritis is caused by the bacteria H. pylori.^[18] These bacteria create an inflammation of the stomach lining and, gradually, stomach cells become damaged. Infection with_H. pylori_ is usually acquired in childhood, though symptoms do very often not develop until later in life.

Chronic gastritis can also be caused by several chemical substances. These causes include:

• Repeated, high dose and/or prolonged use of certain pain-relievers such as aspirin, which may also be prescribed for non-pain treatment in lower doses, e.g., after a heart attack, or NSAID drugs such as ibuprofen or naproxen- Excessive consumption of alcohol.
• Bile, a liquid the liver produces to aid digestion, entering the stomach. This is known as bile reflux

A small number of cases of chronic gastritis are caused by an autoimmune reaction (Type chronic gastritis).^[28][29]

Causes of autoimmune chronic gastritis

An autoimmune reaction can also cause chronic gastritis. The body’s autoimmune response causes inflammation of the protective mucus-covered lining of the stomach, which eventually affects and degrades the mucus-producing cells. This leads to fewer mucus-producing cells being available and, consequently, less protection for the stomach. This is accompanied by a loss of parietal cells in the stomach, which regulate stomach acid. Parietal cells also affect the absorption of vitamin B12 and iron by the stomach. So damage or loss of these cells may cause the body to have less vitamin B12 and iron available for its various processes and therefore lead to anemia and other deficiency symptoms (see symptom section above).^[6]

It is not yet known what causes the autoimmune reaction, but people with autoimmune chronic gastritis often also have other autoimmune conditions such as autoimmune thyroiditis, Addison’s disease or type I diabetes.^[6][7]

Chronic gastritis risk factors

Certain population groups and people who overuse certain substances are at increased risk of chronic gastritis:^[30][31][32]

• Habitual use of painkillers such as aspirin, ibuprofen and naproxen can change the composition of the stomach lining, leaving it less protected and causing both acute and chronic gastritis
• Excessive alcohol consumption is another common risk factor
• Infection with H. pylori (type B) is a big risk factor for developing acute as well as chronic gastritis.. Incidences of H. pylori infection have been falling in the developed world since the 1960s, likely due to better hygiene practices

Chronic gastritis diagnosis

To assist with the diagnosis of chronic gastritis, a doctor will take the person’s medical history, including their use of medications such as aspirin, NSAID pain-relievers and antacids, as well as alcohol consumption and travel to countries where infection with H. pylori is common. For example, around nine out of every 10 people in Nigeria, Portugal and Estonia are estimated to be infected with H. pylori.^[33] . The doctor will also conduct a physical examination of the abdomen/belly.

Depending on these factors, a number of tests may be used for helping with diagnosis or evaluating potential causes:^[5][7]

• Testing for H. pylori. These tests may include a blood, stool or breath tests
• Blood tests for anemia
• Blood tests to find antibodies^[34] that mistakenly provoke an immune response against cells in a person’s own stomach
• Liver and kidney function blood tests
• Stool tests for the presence of blood

Other tests may include:

EGD (esophagogastroduodenoscopy), also called gastroscopy or upper endoscopy: An EGD is a visual inspection of the stomach lining, performed by passing an endoscope – a long, thin, flexible tube with a lighted camera – down the throat and into the esophagus, stomach and upper small intestine. The doctor can examine the stomach lining for signs of inflammation and take a small tissue sample (biopsy) to test for H. pylori.^[35] An EGD is the best diagnostic tool for autoimmune chronic gastritis.^[6]

Upper gastrointestinal (GI) series: Also called a barium swallow, this test creates a series of X-rays of the GI tract. Swallowing a liquid containing barium (a metal compound) coats the inside of the stomach, esophagus and small intestine to make the organs, as well as any potential ulcer presence, polyps or other abnormality, more visible by X-ray.

Treatment for chronic gastritis

How chronic gastritis is treated depends on the underlying cause. If the condition is caused by prolonged and excessive use of NSAIDs or alcohol, the person will need to stop taking those substances. A medical professional will be able to assist with replacement painkillers or with any withdrawal effects and also redirect to other needed support, e.g., support groups for quitting alcohol.^[28]

TreatingH. pylori

Antibiotics can treat H. pylori infection. Ridding the body of these bacteria will often cure gastritis.[5]
In the first instance, a combination of three drugs is usually used to treat H. pylori infection. This treatment will usually include a proton pump inhibitor (PPI), a medication that lessens the amount of acid produced by the stomach, as well as two antibiotics. This is known as triple therapy and the course of treatment runs for between 10 and 14 days.^[36][37][38]

In the majority of cases, triple therapy will successfully clear up the infection. If additional treatment is required, then doctors will often recommend quadruple therapy. This involves a PPI and three antibiotics and also runs for between 10 and 14 days.

Treating intestinal metaplasia

Chronic gastritis can lead to a change in the stomach lining known as intestinal metaplasia (IM). This is when the cells in the stomach change and become more like the cells in the intestine. IM is associated with an increased risk of cancer, but the risk still remains low.

While treating H. pylori infection removes chronic gastritis, it remains unclear whether this treatment will also prove effective at reversing intestinal metaplasia. Evidence suggests that removing H. pylori may at least slow down IM.^[39]

Treatment for autoimmune chronic gastritis

Currently, there is no treatment available that will cure autoimmune chronic gastritis. However, the vitamin B12 and iron deficiencies that it often causes can be treated with supplements, in the form of tablets, shots or intravenous infusions.^[6][7]

Even though autoimmune chronic gastritis cannot be removed by treatment, the risk of developing gastric cancer as a complication of the condition is still modest to low. Nevertheless, a doctor may recommend follow-up endoscopies to detect any early signs of gastric cancer. Treatment on gastric cancer is generally more effective the earlier the condition is detected and treated.

Follow-up endoscopies may be recommended to monitor the development of atrophic gastritis and to detect any early signs of gastric cancer which will allow to then treat it as soon as possible with the best possible outcome.^[7]

Diet and home remedies for chronic gastritis

Diet does not play a role in causing chronic gastritis, though to ease symptoms, people may find it advisable to stop eating things that irritate the stomach, such as fatty, spicy or highly acidic foods. Some people choose to reduce foods containing lactose or gluten.

Other lifestyle changes that may help include eating smaller, more frequent meals rather than larger meals, weight reduction, and stress management.

Over-the-counter medicines, such as antacids, may ease stomach and digestive symptoms but will not address the underlying problem. Over-the-counter medicines should not be taken often and relied upon. A medical professional should be consulted if symptoms persist for more than a week or are severe.

Chronic gastritis FAQs

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1. Ned Tijdschr Geneeskd. [“Gastritis C, non-A non-B and the Sydney system: European unification or tower of Babel?”].(https://www.ncbi.nlm.nih.gov/pubmed/2030784) April 1991. Accessed: May 8, 2018. ↩

2. Medscape. “Chronic Gastritis.” December 2017. Accessed: May 8, 2018. ↩ ↩ ↩

3. Medscape. “Chronic Gastritis: Background.” December 2017. Accessed: May 8, 2018. ↩

4. Medscape. “Acute gastritis.” October 12 2016. Accessed: October 23, 2018. ↩

5. National Institute of Diabetes and Digestive and Kidney Diseases. “Gastritis.” July 2015. Accessed: May 8, 2018. ↩ ↩ ↩

6. US National Library of Medicine. “Autoimmune Gastritis.” September 2016. Accessed: May 8, 2018. ↩ ↩ ↩ ↩ ↩ ↩

7. Genetic and Rare Diseases Information Center. “Autoimmune atrophic gastritis.” November 2016. Accessed: May 8, 2018. ↩ ↩ ↩ ↩ ↩ ↩ ↩

8. MedlinePlus. “Pernicious anemia.” February 2016. Accessed: May 8, 2018. ↩ ↩

9. Pernicious Anaemia Society. “Symptoms of Pernicious Anaemia.” Accessed: May 8, 2018. ↩

10. Medscape. “Vitamin B-12 Associated Neurological Diseases Clinical Presentation.” November 2017. Accessed: June 8, 2018. ↩

11. Patient Info. “Iron-deficiency Anaemia.” April 2018. Accessed: 8 May, 2018. ↩

12. NHS Choices. “Iron deficiency anaemia.” January 2018. Accessed: May 8, 2018. ↩

13. Patient Info. “Stomach Ulcer.” March 2018. Accessed: May 8, 2018. ↩

14. MedlinePlus. “Peptic Ulcer.” May 2016. Accessed: May 8, 2018. ↩ ↩

15. Mayo Clinic. “Peptic ulcer.” March 2018. Accessed: June 8, 2018. ↩

16. National Institute of Diabetes and Digestive and Kidney Diseases. “Symptoms & Causes of Peptic Ulcers.” November 2014. Accessed: May 8, 2018. ↩

17. Medscape. “Atrophic Gastritis Clinical Presentation.” June 2016. Accessed: May 8, 2018. ↩

18. US National Library of Medicine. “Chronic gastritis.” April 2015. Accessed: May 8, 2018. ↩ ↩ ↩

19. US National Library of Medicine. “Pathology of Gastric Intestinal Metaplasia: Clinical Implications.” July 2010. Accessed: May 8, 2018. ↩

20. Humanitas Research Hospital. “Stomach Polyps.” Accessed: May 8, 2018. ↩

21. Medscape. “Benign Gastric Tumours.” November 2017. Accessed: May 8, 2018. ↩

22. BMJ Journals. “The management of gastric polyps.” July 2010. Accessed: May 8, 2018. ↩

23. Endoscopy. “Management of precancerous conditions and lesions in the stomach (MAPS): guideline from the European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter Study Group (EHSG), European Society of Pathology (ESP), and the Sociedade Portuguesa de Endoscopia Digestiva (SPED)..” September, 2016. Accessed: 26 October, 2018. ↩

24. Gastrointestinal Endoscopy. “Screening and surveillance for gastric cancer in the United States: Is it needed?”. July, 2016. Accessed: 26 October, 2018 ↩

25. Gut and Liver. “Diagnosis and Management of High Risk Group for Gastric Cancer”. January, 2015. Accessed: 26 October, 2018. ↩

26. Revista de Enfermería “Influence of diet in primary prevention of gastric cancer in patients infected with Helicobacter Pylori.” May, 2016. Accessed: 25 October, 2018 ↩

27. European Journal of Cancer.“Diet and cancer prevention: Contributions from the European Prospective Investigation into Cancer and Nutrition (EPIC) study.”. September, 2010. Accessed: 25 October, 2018. ↩

28. MedlinePlus. “Gastritis.” January 2017. Accessed: May 8, 2018. ↩ ↩

29. US National Library of Medicine. “How do NSAIDs cause ulcer disease?” February 2000. Accessed: May 8, 2018. ↩

30. Johns Hopkins Medicine. “Gastritis.” Accessed: May 8, 2018. ↩

31. QJM. “Relationship between the birth cohort pattern of Helicobacter pylori infection and the epidemiology of duodenal ulcer.” August 2002. Accessed: May 8, 2018. ↩

32. US National Library of Medicine. “Increased risk of Helicobacter pylori associated with birth in wartime and post-war Japan.” February 1996. Accessed: May 8, 2018. ↩

33. Gastroenterology. “Global Prevalence of Helicobacter pylori Infection: Systematic Review and Meta-Analysis.” August, 2017. Accessed: 24 October, 2018. ↩

34. Antibodies are proteins that the immune system used to neutralize infectious microorganisms in the body. ↩

35. Mayo Clinic. “Gastritis: Diagnosis and treatment.” March 2018. Accessed: May 8, 2018. ↩

36. Medscape. “Helicobacter pylori Infection Treatment.”. 13 July, 2018. Accessed: 24 October, 2018. ↩

37. Medscape. “Chronic Gastritis Treatment & Management.”. 20 December, 2017. Accessed: 24 October, 2018. ↩

38. UpToDate. [“Patient education: Helicobacter pylori infection and treatment (Beyond the Basics).”] 19 September, 2018. Accessed: 24 October, 2018. ↩

39. US National Library of Medicine. [“Follow-up of intestinal metaplasia in the stomach: When, how and why”]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312926/) March, 2012. Accessed: 24 October, 2018. ↩

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**Question: What is ‍Chronic Gastritis?**



**Answer:**



Chronic gastritis is a​ long-lasting (chronic) inflammation of the lining of the stomach (gastric mucosa). It can be caused by various factors, including:



* **Helicobacter pylori (H. pylori) infection:** This⁣ bacteria is ⁤the most common cause of chronic gastritis.

* **Autoimmune disorders:** ‍The immune⁤ system mistakenly ‍attacks ⁢the stomach’s‍ lining.

* **Non-steroidal anti-inflammatory drugs (NSAIDs):** Prolonged use of these ⁤medications can ⁤damage the‌ stomach lining.

* **Alcohol abuse:** Excessive alcohol consumption can irritate⁤ and erode the gastric mucosa.



**Types​ of Chronic ‍Gastritis:**



There ‌are two main types of⁢ chronic gastritis:



* **Type‍ A:** Primarily affects ‍the body of ⁢the stomach; associated with autoimmune⁤ disorders.

* **Type B:** Primarily affects the⁢ antrum (lower part of the stomach); usually ⁤caused by H. pylori infection.



**Symptoms:**



Chronic ⁣gastritis often has no symptoms. However, some individuals may experience:



* Abdominal‍ pain or discomfort

* Indigestion

* Nausea or vomiting

* Bloating

* Heartburn

* Loss of appetite

* Weight⁣ loss (in ⁣severe cases)



**Diagnosis:**



Chronic ‍gastritis can‌ be diagnosed​ through:



* ​**Upper endoscopy:** A thin, flexible ‌tube with ⁣a ‌camera is inserted into the stomach‍ to visualize its lining.

* **Biopsy:** A small sample of the stomach lining⁤ is‌ taken for examination⁣ under a microscope.



**Treatment:**



Treatment aims ‍to address the underlying cause and reduce inflammation:



* **Antibiotics:** To eradicate H. ‍pylori‌ infection.

* **Proton pump inhibitors⁣ (PPIs):** To reduce stomach acid production.

*⁣ **H2 receptor antagonists:** To block histamines that stimulate acid secretion.

* **Immunosuppressant drugs:** For autoimmune gastritis.



**Lifestyle Modifications:**



*⁤ Limit alcohol and NSAID use.

* Quit smoking.

* ‌Follow a​ healthy diet (e.g., antioxidant-rich fruits and vegetables).

* Manage stress levels.



**Complications:**



Untreated chronic gastritis can lead to:



* Stomach ulcers

* Gastric⁢ bleeding

* Scarring and thickening of the stomach lining

* Gastric cancer (rare)



**Prevention:**



Preventing H. pylori infection (e.g., through⁤ good hygiene) can reduce the risk of chronic gastritis.​ Additionally,⁤ limiting alcohol use, avoiding NSAIDs, and following a ​healthy diet can help maintain stomach health.