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Gastritis: Overview
Created: June 30, 2015; Last Update: June 28, 2018; Next update: 2021.

Introduction
The membranes lining the stomach wall protect it from acid and germs. If this protective lining is
irritated or damaged, it can become inflamed. Long-lasting inflammations can further damage
the stomach lining and lead to stomach (gastric) ulcers.

Inflammation of the stomach lining is called gastritis. It's usually caused by certain bacteria or
the regular use of anti-inflammatory painkillers.

There are two kinds of gastritis: acute and chronic. Acute gastritis is typically accompanied by
very noticeable stomach and bowel problems that usually go away again on their own after a few
days. Chronic gastritis, on the other hand, may go unnoticed. Sometimes it's not discovered until
stomach ulcers have developed, which then cause noticeable symptoms.

Symptoms
The symptoms of acute gastritis include the following:

• Stomach pain

• Feeling full

• Heartburn

• Nausea and sometimes vomiting

• Belching

• Lack of appetite

• A bloated stomach

Some of these symptoms may also be signs of other conditions like gastro-esophageal reflux
disease (GERD), an irritable stomach or bowel, and tummy bugs (gastroenteritis).

People with chronic gastritis often only have mild symptoms, or none at all. But they may have
symptoms like those associated with acute gastritis.

Causes
Common causes of gastritis include an infection with Helicobacter pylori bacteria and taking
anti-inflammatory painkillers known as NSAIDs.

Helicobacter pylori bacteria

Helicobacter bacteria upset the balance of stomach acid production. As a result, too much acid is
made. This can damage the lining and wall of the stomach. But Helicobacter infections only
rarely lead to gastritis: Although an estimated 40 out of 100 people in Germany have
Helicobacter pylori in their stomach, only about 4 to 8 of them develop gastritis or a peptic
(stomach or duodenal) ulcer.

The bacteria can be spread through saliva (spit), vomit, stool, drinking water or food. It is
thought that most people already become infected in childhood, through close contact with
family members.

Non-steroidal anti-inflammatory drugs (NSAIDs)

This group of drugs includes acetylsalicylic acid (the drug in medicines like Aspirin), diclofenac,
ibuprofen and naproxen. Side effects are rare when these painkillers are taken for only a short
time to treat acute pain. But if they are used for a longer time – such as several weeks or months
– they may affect the protective function of the stomach lining because they block the production
of the hormone prostaglandin. One of the things prostaglandin does is regulate the production of
gastric (stomach) mucus and substances that neutralize stomach acid. If there's not enough
prostaglandin, the stomach wall no longer has enough protection against stomach acid.

Combining painkillers with steroids can make this damaging effect worse.

Other causes

Smoking, long-term stress and certain kinds of foods (like fatty, sugary or spicy dishes) may also
cause stomach problems. Drinking too much alcohol can lead to acute gastritis too.

Another, less common, cause of gastritis is a condition called bile reflux. This is where bile flows
upward out of the small intestine and into the stomach, where it damages the lining.

Prevalence
Gastritis is common in Germany. It is estimated that 20 out of 100 people have acute gastritis at
some point in their lives. Most women get gastritis between the ages of 45 and 64, and most men
develop it over the age of 65. The risk of gastritis generally increases with age.

Effects
If the lining of the stomach or bowel no longer provide enough protection, their walls may
become inflamed or damaged. An ulcer may develop in the stomach or duodenum as a result.
The duodenum is the first part of the small intestine, just after the stomach. Gastric (stomach)
ulcers and duodenal ulcers can lead to serious complications like bleeding.

If gastritis becomes chronic and the membrane lining is always inflamed, you might become
anemic too. Cancerous tumors may develop, but that is very rare.

Diagnosis
To find out what is causing the symptoms, the doctor will first feel your stomach and upper
abdomen area. Depending on the type of symptoms, your stomach might also be examined from
the inside to find out more. This examination takes five to ten minutes. It is done using an
instrument called a gastroscope which is gently inserted into your stomach through your mouth
and food pipe. Doctors can use the gastroscope camera to look at the walls of your food pipe
(esophagus), stomach and duodenum. In this way, they can find changes such as inflammation or
bleeding in the stomach lining. They can also use the gastroscope to take some tissue from the
lining and then have the sample checked for Helicobacter pylori bacteria or cell changes such as
cancer.
Sometimes a special breath test is done to confirm the presence of a Helicobacter pylori
infection. These bacteria can also be detected using a blood test or stool test.

Treatment
If you notice that certain foods, stress, alcohol or nicotine make the stomach problems worse,
you can try changing your diet, avoiding alcohol, quitting smoking and/or reducing stress in your
daily life. If these lifestyle changes are not enough to relieve the symptoms, medication is
considered.

Gastritis is typically treated with acid-lowering medication. Depending on the type and severity
of the symptoms, the following drugs can be used:

• Proton pump inhibitors (PPIs) like omeprazole or pantoprazole reduce the production of
stomach acid.

• H2 blockers such as ranitidine and famotidine also reduce acid production.

• Antacids like aluminium hydroxide or magnesium hydroxide neutralize the acid already in
your stomach.

If the gastritis is caused by a Helicobacter infection, proton pump inhibitors are combined with
two or three antibiotics.

If it's caused by a painkiller, you can consult your doctor about switching to a different
medication or combining the painkiller with an acid-lowering drug. Should an NSAID have to be
taken regularly, it's possible to take it along with acid-lowering medication from the start, as a
precaution.

Further information
When people are ill or need medical advice, they usually go to see their family doctor first. Read
about how to find the right doctor, how to prepare for the appointment and what to remember.

Sources

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IQWiG health information is written with the aim of helping people understand the
advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to
the German health care system. The suitability of any of the described options in an
individual case can be determined by talking to a doctor. We do not offer individual
consultations.

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Bookshelf ID: NBK310265