Gastritis

The symptoms of acute gastritis include the following:

• Stomach pain
• Feeling full
• Flatulence (“gas”)
• Heartburn
• Nausea and sometimes vomiting
• Belching
• Loss of appetite
• Bloated belly

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

Gastritis is most commonly caused by an infection with Helicobacter pylori bacteria or taking inflammation-reducing painkillers known as NSAIDs.

These 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.

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. Prostaglandin regulates 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.

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

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.

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.

If the lining of the stomach or bowel no longer provides 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. In rare cases, gastric (stomach) ulcers and duodenal ulcers may 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.

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 (esophagus). Doctors can use the gastroscope camera to look at the walls of your food pipe, stomach and duodenum. That 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 abnormal cells 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.

Gastritis is treated in various ways, depending on what the symptoms and causes are, and how severe the inflammation is.

It is important to avoid alcohol and nicotine (smoking) if you have acute gastritis. Doctors commonly recommend eating food that is gentle on your stomach, like toast or porridge, while avoiding coffee and foods that are greasy or spicy. Getting some rest is also advisable. They also often recommend eating either small portions or nothing at all for one to two days. There has hardly been any scientific research on whether these things can help, though.

If you notice that stress is making your stomach problems worse, you can try coping with it differently and look for ways to relax more in your everyday life.

If the problems don't go away or are very severe, gastritis is usually treated with medication that reduces the amount of acid. Until the symptoms go away, the following medications can be used, depending on the type and severity of the symptoms:

• Antacids like aluminium hydroxide or magnesium hydroxide neutralize the acid already in your stomach.
• Proton pump inhibitors (PPIs) like omeprazole or pantoprazole reduce the production of stomach acid.
• H2 blockers such as famotidine also reduce acid production.

If the gastritis is caused by a Helicobacter infection, proton pump inhibitors are combined with two antibiotics and bismuth. Bismuth is a non-toxic heavy metal that inhibits the growth of bacteria and forms a protective film over the damaged mucous membrane. The treatment lasts at least ten days.

If it's caused by a painkiller, you can ask your doctor about switching to a different medication or combining the painkiller with an acid-lowering drug.

Anyone who regularly takes NSAIDs and has an increased risk of a stomach ulcer – for example, because they have already had an ulcer – can also take an acid-lowering medication as a precaution. Your doctor can give you advice on this.

When people are ill or need medical advice, they usually go to see their family doctor first. Information about health care in Germany can help you to navigate the German health care system and find a suitable doctor. You can use this list of questions to prepare for your appointment.