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Chronic Gastritis

  1. What is chronic gastritis?
  2. Symptoms
  3. Causes
  4. Risk factors
  5. Diagnosis
  6. Treatment
  7. FAQ

What is chronic gastritis?

Chronic (long-lasting) gastritis is a condition where the mucus lining of the stomach is persistently inflamed or irritated. Symptoms appear slowly, over time,

There are three main types of chronic gastritis, depending on their different causes:[1][2]

  • Type A: autoimmune gastritis
  • Type B: infection with bacteria helicobacter pylori (H. pylori)
  • Type C: Prolonged use of alcohol or painkillers, like nonsteroidal anti-inflammatory drugs (NSAIDs)

Cases of chronic gastritis are declining in developed countries, and most people respond well to treatment.

Without treatment, chronic gastritis can progress over years to the point where the stomach lining is so damaged, the person is at risk of ulcers, gastric cancers and, more commonly in cases of autoimmune gastritis, anemia.[3][4]

Chronic vs. acute gastritis

Chronic gastritis is similar to acute gastritis, but has a more gradual onset. The person with the condition may not notice symptoms. When pain appears, it is dull and long-lasting, whereas acute gastritis sets in quickly, but the pain is usually brief.[5]

Depending on the underlying cause, chronic gastritis can generally be treated relatively simply. However, it can be linked to more serious conditions such as peptic ulcers, gastric polyps, Crohn’s disease or stomach cancer. Chronic gastritis often improves quickly once treatment has begun.

For more information, see the resource on acute gastritis.

Gastritis vs. gastroenteritis

Both acute and chronic gastritis directly affect the stomach and cause nausea and vomiting. Gastroenteritis affects both the stomach and intestines and may also cause diarrhea.

Symptoms of chronic gastritis

The majority of people infected with H. pylori do not develop any symptoms and present no complications.[6]

People who experience symptoms from chronic gastritis rather than its various complications, may experience:[1][7]

  • Pain or an ache in the upper abdomen
  • Nausea
  • Vomiting
  • A feeling of being full
  • Feeling hungry combined with reduced appetite
  • Pain while fasting
  • Pain after eating

People experiencing possible symptoms of chronic gastritis can use the free Ada app to carry out a symptom assessment.

Symptoms of type A autoimmune chronic gastritis

People with autoimmune chronic gastritis will not generally experience pain or will not experience pain as strongly as those with chronic gastritis caused by H. pylori or NSAIDs.[8]

The main symptom with autoimmune chronic gastritis is pernicious anemia, caused by a lack of vitamin B12, or iron deficiency anemia.[8][9]

Symptoms of pernicious anemia include:[9][10][11]

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

Symptoms of iron deficiency anemia include:[12][13]

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

Some people with autoimmune chronic gastritis may experience a full feeling in the upper abdomen after eating, feel nauseous or vomit. Although most people with the condition do not experience pain, some may feel pain in the abdomen.[14]

Complications

Chronic gastritis can lead to other conditions if not properly managed. These include:

Atrophic gastritis

If left untreated, severe 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 this is still a low risk overall.[3][4][6][15]

Atrophic gastritis on its own does not tend to cause symptoms. It is often diagnosed during an internal examination of the stomach after a person exhibits other signs of gastritis, such as:[3]

  • Stomach pain
  • Nausea and vomiting
  • Bloating

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:[16][17][18]

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

These symptoms usually:[17][19]

  • 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

Gastric polyps

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 rare cases, bleeding

Most gastric polyps are benign, but some can develop into gastric cancers.[22]

Causes

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

In around 90% of cases, chronic gastritis is caused by the bacteria H. pylori.[4] This bacteria creates an inflammation of the stomach lining and, gradually, stomach cells become damaged. H. pylori is usually acquired in childhood, though symptoms do not develop until later in life.

Another cause of damage to the mucus layer is the repeated use of NSAID drugs, such as aspirin, and excessive consumption of alcohol. These substances can irritate the mucus lining of the stomach. A small number of cases of chronic gastritis are caused by an autoimmune reaction.[23][24]

Causes of autoimmune chronic gastritis

An autoimmune reaction can also cause chronic gastritis. The body’s autoimmune response causes an inflammation of the protective mucus lining of the stomach, which eventually atrophies 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 their loss may cause malabsorption.[8]

It is not known what causes the autoimmune reaction, but people with autoimmune chronic gastritis often have other autoimmune conditions such as autoimmune thyroiditis, Addison’s disease or type I diabetes.[8][14]

Risk factors

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

  • Habitual use of painkillers like 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.[25]
  • Infection with H. pylori (type B) is more common among older people. Incidences of H. pylori infection have been falling in the developed world since the 1960s, likely due to better hygiene practices.[26][27]

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, NSAIDs and antacids, as well as alcohol consumption and travel to countries where H. pylori is endemic. They will also conduct a physical examination of the abdomen.

Depending on these factors, a number of tests may be used for a diagnosis:[7]

  • Testing for H. pylori: These tests may include a blood, stool or breath test.
  • Blood test for anemia
  • Stool test 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 intestine. The doctor can examine the stomach lining for signs of inflammation and take a small tissue sample (biopsy) to test for H. pylori.[28] An EGD is the best diagnostic tool for autoimmune chronic gastritis.[8]

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 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.[23]

TreatingH. pylori

Antibiotics can treat H. pylori infection. Ridding the body of these bacteria will usually cure the gastritis.[7] However, there is still not enough evidence to determine whether curing the infection can reverse intestinal metaplasia and reduce the risk of cancer.[6][29]

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 causes can be treated with supplements, in the form of tablets, shots or intravenous infusions.[8][14]

Follow-up endoscopies may be recommended to monitor development of atrophic gastritis and detect early signs of gastric cancer.[14]

Diet and home remedies

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 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.

Chronic gastritis FAQs

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 stomach may be permanent.

Q: Is chronic gastritis dangerous?
A: Chronic gastritis is not dangerous, unless it develops into a more serious stage. If chronic gastritis progresses to atrophic gastritis it can increase the risk of developing ulcers, polyps, anemia and gastric cancers.

Q: Is chronic gastritis the same as antral gastritis?
A: Gastritis can affect any part of the stomach, but antral gastritis affects only the lower portion, known as the antrum. Causes are the same, but symptoms may also include indigestion and flatulence.


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