Gastritis

What is gastritis?

Many people -- including some doctors -- use "gastritis" as a fancy word for stomachache, but the term really means "inflammation of the stomach." Most people with sore stomachs don't have gastritis. When inflammation does set in, it can cause considerable pain and discomfort. Fortunately, gastritis is usually easy to control. You may need to make a few lifestyle changes or get a little help from your doctor, but you don't have to put up with the pain.

What causes gastritis?

Most people with gastritis can blame a tiny germ, namely Helicobacter pylori. This bacterium, usually caught during childhood, is basically immune to stomach acid. It can survive happily in the mucus lining of the stomach for decades, often causing no trouble at all. In some people, however, the germ burrows deep into the stomach lining, causing gastritis. In many cases, a peptic ulcer may not be far behind.

Regular doses of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen are another major source of gastritis. These pills all have the potential to damage the lining of the stomach. The harm is usually minor and your stomach will probably recover within a few days. But if you take too many pills, use painkillers on a daily basis, or if your stomach doesn't heal as quickly as it should, the lining can easily become inflamed. Like H. pylori, NSAIDs are a leading cause of ulcers.

For unknown reasons, severe injuries to other parts of the body often lead to gastritis. Emotional distress can cause gastritis by boosting the flow of acid in your stomach. Other possible causes include heavy drinking, and, rarely, illnesses such as Crohn's disease.

Anything that irritates the stomach can make an existing case of gastritis feel much worse. The list of possible offenders includes alcohol, smoking, emotional stress, and some medications, including potassium and iron supplements.

What are the symptoms of gastritis?

Some people with gastritis don't have any symptoms at all, even though the inflammation may show up clearly during tests such as an endoscopy (an examination in which the doctor slides a thin tube equipped with a tiny camera on one end down your throat to take a look at your stomach). Most people, however, will have some stomach pain and occasional indigestion. The pain may be burning or gnawing, and it usually gets worse on an empty stomach. Most people feel better after eating. Other symptoms may include bloating, nausea, and even vomiting.

These symptoms closely mimic the signs of a peptic ulcer. But since both conditions often respond to the same treatments, it isn't always necessary to make the distinction unless the patient is elderly or there are worrisome symptoms such as weight loss or bleeding.

How is gastritis treated?

If you're infected with H. pylori, you may need to take antibiotics to kill the germ. Whether you have gastritis or an ulcer, ridding yourself of the infection is often the key to long-term relief. Likewise, if you take regular doses of NSAIDs, you need to cut back or give them up completely.

Whatever the source of your gastritis, acid-reducing drugs can reduce your symptoms and give your stomach a chance to heal.

Whether you're taking antibiotics, acid-blockers, or both, you may find it helpful to avoid certain foods while you're healing. These -- according to gastroenterologist Dr. Gary Gitnick, head of the digestive diseases division at University of California at Los Angeles -- include acidic foods, such as citrus fruits and juices, spicy foods, and food and drink that helps produce acid, such as chocolate and coffee (even if it's decaffeinated.) Reducing or eliminating your alcohol intake can help, too. Try to find some ways to reduce your stress: it can increase acid production. And if you smoke, stop. Smoking greatly increases the risk of ulcers.

If you're taking any medications that can upset the stomach, your doctor may be able to offer an alternative. For instance, acetaminophen (Tylenol) is generally easier on the stomach than aspirin. (If you drink three or more glasses of alcohol a day, however, Tylenol can be too hard on the liver, so consult your doctor for advice.)

If your stomach pain comes back, or if it doesn't start to fade after seven to 10 days of treatment, you may need an endoscopy to further explore the cause of your distress. Your doctor will slide a gastroscope down your throat and into your stomach. If you have an ulcer, cancer, or any other serious stomach problem, the endoscope will help the doctor find it. If you're over 50 or show any symptoms of serious disease, your doctor will probably suggest you get an endoscopy or other tests right away.

But if your gastritis is caused by your eating or drinking habits, cigarette smoking, or other consequences of your lifestyle, you can make a few basic changes and feel much better for it.

References

Bazaldua OV and FD Schneider. Evaluation and management of dyspepsia. American Family Physician.

Gitnick, Gary, MD, Freedom from Digestive Distress, Three Rivers Press.

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