Chronic Gastritis

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

• 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.

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. 3

Read more about Acute Gastritis »

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 »

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: 4

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

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. 5

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

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. 5 6

Symptoms of pernicious anemia may include: 6 7 8

• 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: 9 10

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

Read more about Anemia ».

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, try a symptom assessment on the Ada app. Some of these complications include:

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: 11 12 13

• 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: 12 14

• 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 »

If left untreated, severe chronic gastritis, especially the Type A autoimmune chronic gastritis, as well as the 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 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. 15 16 2 17

Atrophic gastritis is a 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 are growths that form in the lining of the stomach. They do not usually cause symptoms, but when they do, these can include: 18 19

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

Most gastric polyps are benign, meaning non-cancerous, but some can develop into gastric cancers. 20

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 every one and three years depending on a doctor’s recommendations. 21 22 23

Other effective ways of lowering the chances of gastric cancer include: 24 25

• 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

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. 16 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 A chronic gastritis). 26 27

An autoimmune reaction can also cause chronic gastritis. The body’s autoimmune response causes an 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 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). 5

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. 5

Certain population groups and people who overuse certain substances are at increased risk of chronic gastritis: 28 29 30

• 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

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. 31 . 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: 4

• Testing for H. pylori. These tests may include a blood, stool or breath tests
• Blood tests for anemia
• Blood tests to find antibodies 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. 32 An EGD is the best diagnostic tool for autoimmune chronic gastritis. 5

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.

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. 26

Antibiotics can treat H. pylori infection. Ridding the body of these bacteria will often cure the gastritis. 4In 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 a triple therapy and the course of treatment runs for between 10 and 14 days. 33 15

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

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. 34

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. 5

Even though autoimmune chronic gastritis cannot be removed by treatment, the risk of developing gastric cancer as a complication of the condition is still modestly too 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.

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.

Q: Is there a cure for chronic gastritis?
A: Chronic gastritis caused by H. pylori bacteria or by use of NSAIDs or alcohol can be cured by either eliminating the bacteria or discontinuing use of the substance. However, if a person has had chronic gastritis for a long time, some of the damage to the inner stomach lining may be permanent.

Q: Is chronic gastritis dangerous?
A: Chronic gastritis is itself not dangerous, but can, like acute gastritis, lead to other problems developing, such as ulcers. Furthermore it can develop into a more serious stage. If chronic gastritis progresses to atrophic gastritis it can additionally increase the risk of developing ulcers, anemia, polyps or non-cancerous tumors, and gastric cancers.

Q: What is chronic antral gastritis?
A: Antral gastritis only affects the lower portion of the stomach, known as the antrum rather than the whole organ. Just like gastritis that affects the whole stomach, antral gastritis can either be chronic or acute. Gastritis caused by H. pylori tends to often be focused in the antrum before spreading to the rest of the stomach. 16

Q: What is the gastric mucosa?
A: The gastric mucosa is the internal lining or mucous membrane of the stomach. It is coated by a thick mucus layer and not only produces the acid to break down food entering the stomach, but also protects the stomach from the acid it creates. Gastritis happens when the gastric mucosa is inflamed.

Q: How long does chronic gastritis last?
A: Chronic gastritis, especially the common types due to H. pylori or due to irritants like alcohol or pain medication, usually improves quickly after proper treatment is started. However, if the condition is left untreated, chronic gastritis can affect a person for many months or even years. Potentially, as in the rarer occuring autoimmune gastritis, it may persist, even despite supportive treatment, for the rest of a person’s life.