Gastritis

At a glance

  • Gastritis (inflammation of the stomach lining) is most often caused by bacteria or painkillers.
  • The typical symptoms include stomach pain, and feeling full or bloating.
  • The severity of the symptoms and the cause of the gastritis determine how it is treated.
  • Gastritis can start very suddenly or develop over a longer period of time.

Introduction

Photo of a doctor feeling a patient's belly
PantherMedia / romankosolapov

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 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 or damage the lining of the stomach over time. Sometimes it is 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
  • Flatulence (“gas”)
  • Heartburn
  • Nausea and sometimes vomiting
  • Belching
  • Lack 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.

Causes

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

Helicobacter pylori bacteria

These 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) .

The 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. 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.

Alcohol and other causes

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.

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 provides enough protection to the wall of the stomach or the duodenum, their walls may become inflamed or damaged. An 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 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 (esophagus). Doctors can use the gastroscope camera to look at the walls of your food pipe, stomach and duodenum. In this way, they can find changes such as 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 or abnormal cells such as cancer.

Sometimes a special breath test is done to confirm the presence of a Helicobacter pylori . These can also be detected using a blood test or stool test.

Treatment

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

Treatments without medication

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 1 to 2 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.

Treatment with medication

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 ranitidine and famotidine also reduce acid production.

If the gastritis is caused by a Helicobacter , proton pump inhibitors are combined with two or three . The treatment lasts about 1 to 2 weeks.

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. 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.

Fischbach W, Malfertheiner P, Hoffmann JC et al. S3-guideline "Helicobacter pylori and gastroduodenal ulcer disease" of the German society for digestive and metabolic diseases (DGVS) in cooperation with the German society for hygiene and microbiology, society for pediatric gastroenterology and nutrition, German society for rheumatology. AWMF-registration-no.: 021-001. Z Gastroenterol 2009; 47(12): 1230-1263.

Fischbach W, Malfertheiner P, Lynen Jansen P et al. S2k-Leitlinie Helicobacter pylori und gastroduodenale Ulkuskrankheit. AWMF-Registernr.: 021-001. Z Gastroenterol 2016; 54: 327-363.

Hawkey CJ, Langman MJ. Non-steroidal anti-inflammatory drugs: overall risks and management. Complementary roles for COX-2 inhibitors and proton pump inhibitors. Gut 2003; 52(4): 600-608.

Levenstein S, Rosenstock S, Jacobsen RK et al. Psychological stress increases risk for peptic ulcer, regardless of Helicobacter pylori infection or use of nonsteroidal anti-inflammatory drugs. Clin Gastroenterol Hepatol 2015; 13(3): 498-506.

Malfertheiner P, Megraud F, O'Morain CA et al. Management of Helicobacter pylori infection - the Maastricht IV / Florence Consensus Report. Gut 2012; 61(5): 646-664.

Ramakrishnan K, Salinas RC. Peptic ulcer disease. Am Fam Physician 2007; 76(7): 1005-1012.

Robert Koch-Institut (RKI), Statistisches Bundesamt (Destatis). Gastritis, Magen- und Zwölffingerdarmgeschwüre. (Gesundheitsberichterstattung des Bundes; Heft 55). Berlin: RKI; 2013.

Rostom A, Dube C, Wells GA et al. Prevention of NSAID-induced gastroduodenal ulcers. Cochrane Database Syst Rev 2002; (4): CD002296.

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. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Updated on November 10, 2021
Next planned update: 2024

Authors/Publishers:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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