Gastritis & Gastropathy

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Definition & Facts

What are gastritis and gastropathy?

Gastritis and gastropathy are conditions that affect the stomach lining, also known as the mucosa. In gastritis, the stomach lining is inflamed. In gastropathy, the stomach lining is damaged, but little or no inflammation is present.

Are there different types of gastritis and gastropathy?

Experts have identified many types of gastritis and gastropathy, which have different causes.

Gastritis and gastropathy may be chronic, developing slowly and lasting a long time, or acute, developing suddenly and lasting a short time. Some forms are erosive, meaning that they wear away the stomach lining and cause shallow breaks, called erosions, and ulcers. Other forms are nonerosive.

Common types of gastritis and gastropathy include the following.

H. pylori gastritis

Helicobacter pylori (H. pylori) gastritis is one of the most common types of gastritis. Caused by infection with H. pylori bacteria, this type of gastritis is chronic and one of the most important causes of peptic ulcer disease. Without treatment for the bacterial infection, H. pylori gastritis can last a lifetime and increase the chance of developing stomach cancer.

Helicobacter pylori (H. pylori) bacteria.
H. pylori gastritis is one of the most common types of gastritis.

Reactive gastropathy

Reactive gastropathy develops when the stomach lining comes into contact with irritating substances over a long period of time. Some types of pain relief medicines called nonsteroidal anti-inflammatory drugs (NSAIDs), alcohol, and bile are among the most common irritating substances. Reactive gastropathy is chronic and can be erosive. NSAIDs are the most common noninfectious cause of peptic ulcers and can cause life-threatening bleeding, obstruction, or perforation of the stomach or small intestine.

Autoimmune gastritis

Autoimmune gastritis occurs when the immune system attacks healthy cells in the stomach lining. Autoimmune gastritis is chronic and typically nonerosive.

Acute erosive gastropathy

Acute erosive gastropathy may occur after contact with irritating substances, such as NSAIDS, alcohol, or cocaine. A form of acute erosive gastropathy called stress gastritis develops when serious health problems—such as severe injuries or burns, critical illness, or sepsis—reduce the blood flow to the stomach lining. This reduced blood flow prevents the stomach’s protective mechanisms from working normally, which allows stomach acid to come into contact with and damage the stomach lining.

In acute erosive gastropathy, the stomach lining quickly develops erosions, ulcers, and bleeding. The bleeding is most often mild but may be severe.

How common are gastritis and gastropathy?

H. pylori gastritis is the most common type of gastritis, and nearly everyone who is infected with H. pylori develops chronic gastritis. About half of the world’s population is infected with H. pylori bacteria, and this infection is more common in developing countries than in developed countries.1 About 35 percent of the U.S. population is infected with H. pylori.2

Reactive gastropathy, caused by contact with irritating substances, is also relatively common, affecting about 15 percent of people in the United States.3

Other forms of gastritis and gastropathy are less common.

Who is more likely to have gastritis or gastropathy?

H. pylori infection and gastritis are more common in older people than in younger people. While the bacterial infection most often begins during childhood, H. pylori infection has become less common in the United States over time. H. pylori infection is present in about 10 to 15 percent of U.S. children younger than age 12 and in about 50 to 60 percent of U.S. adults older than age 60.1

In the United States, H. pylori infection is more common among African Americans, Hispanics/Latinos, American Indians, and Alaska Natives than among non-Hispanic whites. Compared with people born in the United States, immigrants to the United States from areas where H. pylori infection is more common, such as Asia and Central and South America, are more likely to have H. pylori.4

Reactive gastropathy is more common in people who take NSAIDs and is more common in older people than in younger people. In the United States, reactive gastropathy is present in about 2 percent of children younger than age 10 and in more than 20 percent of adults older than age 80.1

Autoimmune gastritis is more common in people who have other autoimmune disorders, including type 1 diabetes, Addison’s disease, and autoimmune thyroid diseases such as Hashimoto’s disease.

What are the complications of gastritis and gastropathy?

Peptic ulcers

Peptic ulcers are sores on the lining of your stomach or duodenum. Acute erosive gastropathy can cause peptic ulcers. H. pylori gastritis and reactive gastropathy, especially from NSAIDs, also increase your chance of developing peptic ulcers.

Anemia

H. pylori gastritis and autoimmune gastritis can cause problems absorbing iron from food, leading to iron-deficiency anemia.

Autoimmune gastritis can cause problems absorbing vitamin B12 from food. Without enough vitamin B12, the body can’t make enough healthy red blood cells, leading to pernicious anemia.

Atrophic gastritis

Chronic gastritis, most often H. pylori gastritis and autoimmune gastritis, can lead to atrophic gastritis. In atrophic gastritis, chronic inflammation leads to the loss of the glands in the stomach lining that make stomach acid and enzymes. Atrophic gastritis has also been linked to the development of stomach cancer.

Stomach cancer

Chronic H. pylori gastritis and autoimmune gastritis increase the chance of developing growths in the stomach lining. These growths may be benign or may be stomach cancer. H. pylori gastritis increases the chance of developing a type of cancer called gastric mucosa-associated lymphoid tissue (MALT) lymphoma, a type of adult non-Hodgkin lymphoma. Early diagnosis and treatment of H. pylori can prevent the development of some types of stomach cancer.

References

Symptoms & Causes

What are the symptoms of gastritis and gastropathy?

The majority of people with gastritis or gastropathy don’t have any symptoms.

In some cases, gastritis and gastropathy cause symptoms of indigestion, also called dyspepsia. Symptoms may include

  • pain or discomfort in the upper abdomen
  • nausea or vomiting
  • feeling full too soon during a meal
  • feeling too full after a meal
  • loss of appetite
  • weight loss

If gastritis or gastropathy leads to erosions or ulcers, the stomach lining may bleed. If you have symptoms of bleeding in your stomach, seek medical help right away. Symptoms of bleeding in your stomach may include

  • black or tarry stool or red or maroon blood mixed with your stool
  • cramps, discomfort, or pain in your abdomen
  • feeling tired, short of breath, or light-headed
  • red blood in vomit or vomit that looks like coffee grounds

If you have mild bleeding in your stomach, you may have a small amount of blood in your stool and not notice it. This is called occult bleeding.

What causes gastritis and gastropathy?

Different types of gastritis and gastropathy have different causes.

Common causes of gastritis and gastropathy

Helicobacter pylori (H. pylori) gastritis. Infection with H. pylori bacteria causes H. pylori gastritis. Researchers are still studying how people become infected. H. pylori bacteria may spread from person to person through contact with an infected person’s vomit, stool, or saliva. Food or water contaminated with an infected person’s vomit, stool, or saliva may also spread the bacteria from person to person.

Reactive gastropathy. Reactive gastropathy is caused by long-term contact with substances that irritate the stomach lining, most often nonsteroidal anti-inflammatory drugs (NSAIDs), alcohol, and bile reflux, which is backward flow of bile from the small intestine to the stomach. Surgery that removes part of the stomach, such as some types of bariatric surgery, is the most common cause of bile reflux.

Clear cup of nonsteroidal anti-inflammatory drugs (NSAIDs) spilling out onto table.
Long-term use of NSAIDs may cause reactive gastropathy.

Autoimmune gastritis. In autoimmune gastritis, the immune system attacks healthy cells in the stomach lining.

Acute erosive gastropathy. Serious health problems—such as severe injuries or burns, critical illness, or sepsis—can reduce the blood flow to the stomach lining, causing a form of acute erosive gastropathy called stress gastritis.

Contact with substances that irritate the stomach lining—including NSAIDs, alcohol, and cocaine—can also cause acute erosive gastropathy.

Other causes of gastritis and gastropathy

Less common causes of gastritis and gastropathy include

Diagnosis

How do doctors diagnose gastritis and gastropathy?

Your doctor will ask about your medical history, symptoms, and any medicines you take. Your doctor will also perform a physical exam and may order an upper gastrointestinal (GI) endoscopy with biopsies or other tests.

Upper GI endoscopy

Upper GI endoscopy is a procedure in which a doctor uses an endoscope—a flexible tube with a camera—to see the lining of your upper GI tract, including your esophagus, stomach, and duodenum. During upper GI endoscopy, a doctor obtains biopsies by passing an instrument through the endoscope to take small pieces of tissue from your stomach lining. A pathologist will examine the tissue with a microscope. Doctors may use upper GI endoscopy to diagnose gastritis or gastropathy, determine the cause, and manage complications.

Health care professionals performing an upper GI endoscopy.
Your doctor may order an upper GI endoscopy with biopsies to diagnose gastritis and gastropathy.

Blood tests

Doctors may use blood tests to check for other causes of gastritis or signs of complications. For a blood test, a health care professional will take a blood sample from you and send the sample to a lab.

Stool tests

Doctors may use stool tests to check for H. pylori infection and for blood in your stool, a sign of bleeding in your stomach.

Urea breath test

Doctors may use a urea breath test to check for H. pylori infection. For the test, you will swallow a capsule, liquid, or pudding that contains urea that is “labeled” with a special carbon atom. If H. pylori is present, the bacteria will convert the urea into carbon dioxide. After a few minutes, you will breathe into a container, exhaling carbon dioxide. A health care professional will test your exhaled breath. If the test detects the labeled carbon atoms, the health care professional will confirm an H. pylori infection in your digestive tract.

Upper GI series

Doctors may use an upper GI series to check for signs of gastritis or gastropathy. An upper GI series is a procedure in which a doctor uses x-rays and a chalky liquid called barium to view your upper GI tract.

Treatment

How do doctors treat gastritis and gastropathy?

Your doctor will recommend treatments based on the type of gastritis or gastropathy you have and its cause. Treating gastritis and gastropathy can improve symptoms, if present, and lower your chance of complications.

Health care professional talking with a patient.
Your doctor will recommend treatments based on the type of gastritis or gastropathy you have and its cause.

H. pylori gastritis

Doctors treat Helicobacter pylori (H. pylori) gastritis with a combination of medicines to kill
H. pylori bacteria. These medicines most often include

Your doctor may avoid prescribing antibiotics you’ve taken in the past because the H. pylori bacteria may have developed antibiotic resistance to those antibiotics.

If you are given medicines, take all doses exactly as your doctor prescribes. If you stop taking your medicine early, some bacteria may survive and reinfect you. In other words, H. pylori bacteria may develop antibiotic resistance.

To find out if medicines have worked, your health care professional may recommend testing you for H. pylori at least 4 weeks after you’ve finished taking medicines.4 If you still have an H. pylori infection, your doctor may prescribe a different combination of antibiotics and other medicines to treat the infection. Making sure that all of the H. pylori bacteria have been killed is important to prevent further complications of the infection.

Reactive gastropathy

If long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) leads to reactive gastropathy, your doctor may recommend that you stop taking NSAIDs, take a lower dose, or take a different medicine for pain. Doctors may also recommend taking a PPI along with NSAIDs to prevent or treat reactive gastropathy and its possible complications.

If bile reflux is causing reactive gastropathy, doctors may prescribe ursodiol, a medicine that contains bile acids and can help heal the stomach lining, or surgery to stop flow of bile into the stomach.

Autoimmune gastritis

If you have autoimmune gastritis, your doctor may recommend iron, folic acid, and vitamin B12 supplements to prevent pernicious anemia. If autoimmune gastritis leads to pernicious anemia, doctors may recommend vitamin B12 injections to treat this condition.

For safety reasons, talk with your doctor before using dietary supplements, such as vitamins, or any complementary or alternative medicines or medical practices.

Acute erosive gastropathy

For patients with severe injuries or critical illness, doctors may prescribe medicines that reduce stomach acid such as PPIs, H2 blockers, or sucralfate (Carafate) to prevent or treat stress gastritis.

If an irritating substance is causing acute erosive gastropathy, treatment includes removing contact with the substance. Doctors may also prescribe PPIs or H2 blockers to reduce stomach acid.

If acute erosive gastropathy causes severe bleeding in the stomach, doctors may treat the bleeding during upper GI endoscopy or with surgery in severe cases.

Gastritis or gastropathy due to other causes

To treat gastritis or gastropathy due to other causes, doctors may prescribe medicines to treat the underlying cause or improve symptoms. Doctors may recommend diet changes if gastritis is related to celiac disease or food allergies.

Eating, Diet, & Nutrition

Does diet play a role in causing gastritis and gastropathy?

According to researchers, eating, diet, and nutrition don’t play an important role in causing most cases of gastritis or gastropathy.

However, in a small number of cases, foods, drinks, or supplements may play a role. For example, drinking a large amount of alcohol may cause acute erosive gastropathy, and food allergies may cause gastritis. In rare cases, iron supplements may cause gastritis.

Do gastritis and gastropathy affect nutrition?

Helicobacter pylori (H. pylori) gastritis can cause problems absorbing iron from food, leading to iron-deficiency anemia. Treating the H. pylori infection and taking iron supplements can improve the anemia.

Autoimmune gastritis can cause problems absorbing iron and vitamin B12 from food, which may lead to iron-deficiency anemia and pernicious anemia. Doctors may recommend iron, folic acid, and vitamin B12 supplements to prevent pernicious anemia. If autoimmune gastritis leads to pernicious anemia, doctors may recommend vitamin B12 injections to treat this condition.

For safety reasons, talk with your doctor before using dietary supplements, such as vitamins, or any complementary or alternative medicines or medical practices.

Man taking supplements from a bottle into his hand.
If H. pylori gastritis leads to anemia, treating the infection and taking iron supplements can improve the anemia.

Clinical Trials

The NIDDK conducts and supports clinical trials in many diseases and conditions, including digestive diseases. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life.

What are clinical trials for gastritis and gastropathy?

Clinical trials—and other types of clinical studies—are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help doctors and researchers learn more about disease and improve health care for people in the future.

Researchers are studying many aspects of gastritis and gastropathy, such as

  • differences among strains of H. pylori bacteria and which strains are more likely to cause stomach problems and stomach cancer
  • strategies to prevent stomach cancer in people who have atrophic gastritis
  • whether avoiding certain foods can improve a type of gastritis called eosinophilic gastritis

Find out if clinical studies are right for you.

What clinical studies for gastritis and gastropathy are looking for participants?

You can find clinical studies on gastritis at www.ClinicalTrials.gov. In addition to searching for federally funded studies, you can expand or narrow your search to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe. Always talk with your health care provider before you participate in a clinical study.

August 2019
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This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings through its clearinghouses and education programs to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.

The NIDDK would like to thank:
Brooks D. Cash, M.D., and Victor O. Garcia-Rodriguez, M.D., University of Texas McGovern Medical School