gastritis

Quick Overview

• symptoms: Bloating, upper abdominal pain, loss of appetite, nausea, heartburn, belching, less digestive problems
• Causes: irritant substances (e.g., alcohol, drugs), stress, gastric Helicobacter pylori, autoimmune reactions
• Treatment: Light food, acid binder, proton pump inhibitor, relaxation exercises
• Nutrition: Light food, no alcohol and hot spices, stew instead of frying
• Hazards: Danger of bleeding ulcers, long-term increased risk of gastric cancer

Gastritis: symptoms

Gastritis can cause various nonspecific complaints. The main symptoms are typical for both acute and chronic gastritis. However, they occur suddenly in the acute form, while a chronic gastritis develops slowly.

Common symptoms of gastritis are:

• bloating
• Pain in the upper abdomen
• decreased appetite
• nausea
• Vomit
• heartburn
• burping
• halitosis

Rarer are:

• bloating
• fierce taste in the mouth
• early onset of satiety
• back pain
• diarrhea

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Symptoms of Chronic Gastritis

In chronic gastritis, one distinguishes, depending on the causes, the types A, B and C and various special forms.

Symptoms of Type A Gastritis

Type A gastritis produces less stomach acid. This can cause indigestion. In addition, this form of gastritis results in a vitamin B12 deficiency, which causes a so-called pernicious anemia, a special form of anemia. Symptoms include abnormal sensation, tiredness and fatigue.

Symptoms of Type B Gastritis

Type B gastritis usually shows only nonspecific symptoms. Some patients develop bad breath and in the further course additional diseases such as:

• Duodenal ulcer (ulcer duodeni)
• Stomach cancer (gastric carcinoma)
• MALT lymphoma (mucosa-associated cancer of lymphoid tissue)

Symptoms of Type C Gastritis

Chronic gastritis also causes only unspecific symptoms. Many patients report a malaise in the upper abdomen. Often the symptoms are those of a stomach irritant.

Gastritis: causes and risk factors

A gastritis develops when the protective mucous membrane of the stomach is damaged. These may be stomach irritants or factors that stimulate overproduction of corrosive gastric acid.

Triggers of acute gastritis include:

• excessive consumption of alcohol
• excessive consumption of nicotine
• frequent consumption of foods that irritate the stomach, such as coffee or hot spices
• Frequent or high-dose use of certain medications, such as analgesics or anti-inflammatories such as cortisone
• emotional stress
• Food poisoning by bacteria such as staphylococci or salmonella
• mechanical irritation, such as through a nasogastric tube or other foreign body
• Burns caused by acids or alkalis
• physical stress such as long-term ventilation, traumatic brain injury, burns, brain disorders, major surgery, shock (circulatory collapse)
• Competitive sports (“runners stomach”)

If bacteria such as staphylococci or salmonella are the cause, gastritis may be contagious. The pathogens are then excreted with the stool, and other people can, for example through joint use of the toilet, become infected.

Causes of chronic gastritis

Type A gastritis

Type A gastritis is also referred to as autoimmune chronic gastritis. Autoimmune means that the body’s own defense system is directed against the body itself: it forms antibodies that attack the body’s own structures. Type A gastritis is the rarest form of chronic gastritis with approximately 5 percent of cases.

They attack the parietal cells that produce stomach acid. Therefore, less stomach acid is released. Other antibodies are directed against the intrinsic factor. This protein is produced in the stomach and is necessary for the absorption of vitamin B12. The result is a Vittamin B-12 deficiency.

Type A gastritis accounts for about five percent of chronic gastritis. It can be inherited and affects mainly Northern Europeans. The inflammation is often localized in the main section of the stomach. Many patients additionally suffer from other autoimmune diseases, for example

• Addison’s disease
• Diabetes mellitus type I
• Hashimoto’s thyroiditis (autoimmune thyroiditis)

Type B gastritis

About 80 percent of cases of chronic gastritis are type B. They are usually caused by the bacterium Helicobacter pylori (H. pylori). The stomach germ can be transmitted via saliva or stool. Rarely are also related pathogens the cause of type B gastritis such as Helicobacter heilmannii, which is transmitted from dogs or cats to humans.

The chronic type B gastritis affects the gastric section between the stomach and the stomach outlet (gastric antrum).

Type C gastritis

Chronic gastritis type C accounts for about 15 percent of chronic gastritis. It is caused by a chemical irritation of the stomach. These include above all painkillers such as acetylsalicylic acid (ASA), ibuprofen or diclofenac. They belong to the group of non-steroidal anti-inflammatory drugs (NSAIDs).

The backflow of bile into the stomach (gall bladder) can also cause chronic type C gastritis.

Rare forms of chronic gastritis

Chronic gastritis may have other causes in rarer cases. Among other things, there are the following special forms:

• Eosinophilic (allergic) gastritis: for example, in allergies to cow’s milk or soy
• Lymphocytic gastritis: possibly caused by H. pylori or celiac disease, among other things leads to Ménétrier disease (giant fold gastritis) or anemia (anemia)
• Granulomatous gastritis: in inflammatory diseases such as Crohn’s disease, sarcoidosis or tuberculosis

Gastritis: Therapy

An inflamed or irritated gastric mucosa can often be treated on its own with simple measures. If that is not enough, different medicines help.

The first step in gastritis is to leave out everything that irritates the stomach lining. Coffee, alcohol and nicotine are therefore taboo during gastritis.

If the symptoms are severe, it may make sense to abstain from food for one or two days. As a rule, you do not have an appetite anyway.

Otherwise, it is often enough to eat light food, with easily digestible small meals.

If stress is the trigger of gastritis, relaxation methods can help, such as autogenic training, meditation, or progressive muscle relaxation according to Jacobson.

Useful gastritis home remedies are also:

• Hot water bottle or heat pad
• Chamomile tea (anti-inflammatory)
• Oatmeal (protects the stomach lining)
• Melissa or hops flower tea (soothing)
• potato juice
• Heilerde

Rollkur with chamomile tea: Helpful may be a roll cure for gastritis. Drink two cups of chamomile tea for it. Then lie down on your back for ten minutes. Then turn to the left side, the right side and the stomach for another ten minutes each. Stay for about half an hour after this rolling cure. Use this home remedy daily for a week.

Treatment with drugs

antacids: Rich behavioral measures alone will not help, antacids help. These active ingredients neutralize the aggressive stomach acid.

H2-receptor blockers: Another option is so-called H2-receptor blockers (such as cimetidine or ranitidine). They reduce the production of stomach acid. Thus, the inflamed gastric mucosa can recover and is protected from further damage.

Proton pump inhibitors: Even more effective are so-called proton pump inhibitors (proton pump inhibitors, PPI). They also reduce gastric acid production. Commonly used PPIs are, for example, omeprazole and pantoprazole. However, they should only be taken long-term in exceptional cases and in consultation with the doctor.

antibiotics: Your own type B chronic gastritis needs to get rid of the disease-causing bacteria. A combination of two or three antibiotics together with a proton pump inhibitor for seven days, for example, Helicobacter pylori distribute in over 90 percent of cases.

Antispasmodics and anti-nausea remedies: Against further complaints with gastritis remedies for nausea (antiemetics) or antispasmodic, analgesic remedies (spasmolytics) help.

Vitamin B12: Chronic type A gastritis carries the risk of pernicious anemia. This is caused by a vitamin B12 deficiency. Patients are therefore usually given vitamin B12 injections.

Treatment with alternative medicine

Homeopathy: Homoeopathic agents in gastric mucosal inflammatory agents include Carbo vegetabilis and Lycopodium. They are supposed to relieve the symptoms.

Schüßler salts: Schuessler salts for nausea or belching are, for example, No. 9 sodium phosphoricum, which is to regulate the acidity in the body and No. 7 Magnesium Phosphoricum, which is a relaxing, anticonvulsant effect on digestive organs.

Traditional Chinese medicine: Treatment based on Traditional Chinese Medicine (TCM) – such as acupuncture – can also relieve gastritis symptoms, as patients report

Emergency stomach bleeding!

Sometimes mucosal damage in gastritis is so pronounced that bleeding occurs. In mild cases, these can be stopped as part of a gastroscopy (gastroscopy). Heavy bleeding – recognizable by bloody vomiting or dark stained chair (tarry stool) – can be life-threatening. They require emergency treatment. Sometimes only surgery can stop the bleeding.

nutrition

Gastritis is all about not irritating the gastric mucosa any further. Many patients with acute gastritis still have a lack of appetite, so they do without food for one to two days. It is then important to absorb enough liquid, such as chamomile tea or clear broth.

The following tips for gentle on the stomach can also help you:

• Avoid stomach-irritating substances such as citrus fruits, coffee, alcohol, hot spices
• Oatmeal, rusks, soups, rice and mashed potatoes are particularly gentle on the stomach
• Better to have five small meals spread throughout the day than a few large ones
• Raw food burdens sensitive stomachs. The most digestible are steamed dishes.
• Unfavorable are high-fat foods

For more information on the diet for gastritis read in the article Gastritis: Nutrition.

Examinations and diagnosis

If you have stomach problems, first visit your family doctor. If necessary, he will later refer you to a gastroenterologist, a gastroenterologist. First, your doctor will ask you in detail about your medical history (anamnesis). He asks, for example:

• Since when are you having those complaints?
• Do you suffer from abdominal pain, vomiting or diarrhea?
• Do you take medications, such as painkillers?
• Do you feel a feeling of fullness?

Physical examination

After that, your doctor will examine you. For this he listens to your stomach, where he registers both the bowel sounds and the pulse rate of the large blood vessels of the stomach. Then he taps your belly off. So he can detect air or fluid accumulation. When palpating the abdomen, the doctor pays attention to possible hardening. He also palpates your liver under the right costal arch and your spleen under the left costal arch.

endoscopy

A gastritis can only be clearly diagnosed by the doctor looking into the inside of the stomach. In a so-called endoscopy, a thin tube with a small camera at the tip is gently advanced through the esophagus into the stomach. This allows the doctor to detect possible changes in the mucous membrane, such as redness, swelling or bleeding.

biopsy

With the help of fine instruments, the doctor can also remove a tissue sample from the mucosa during the endoscopic examination. This tissue sample examines a pathologist under his microscope more closely to determine the type of inflammation. He can detect whether the inflammation on the upper mucosal layers limited (surface gastritis) or has already damaged the gastric glands (atrophic gastritis).

Test for Helicobacter pylori

In addition, he can perform with the help of biopsy a urease rapid test for the gastric bacterium Helicobacter pylori. It is the most common trigger for chronic gastritis. For this purpose, the tissue sample urea is added. If the bacterium is present, its enzyme (the urease) will convert the urea into ammonia. This reaction can be measured.

Other test methods for identifying H. pylori as the cause of chronic gastritis are:

• Breath test: The patient receives radioactively labeled urea. H. pylori cleaves this, which can be detected in the exhaled air radioactively labeled carbon dioxide.
• Antigens in the stool: Proteins of H. pylori are excreted via the intestine. These can be detected in the stool.
• Antibodies in the serum: In an infection with H. pylori, the immune system produces antibodies against the bacteria. These can also be detected after a complete infection in the blood of the patient.

Detection of auto-antibodies

If there is a suspicion of type A gastritis, it is investigated for appropriate autoantibodies. If chronic bleeding occurs, the blood picture may detect microcytic anemia, a form of anemia with small red blood cells.

Disease course and prognosis

Acute gastritis usually has a good prognosis. It often heals on its own after a few days or weeks without further treatment. But there are also severe cases, such as when patients have “erosive gastritis”. If bleeding occurs in a so-called haemorrhagic gastritis, it can be life-threatening. In addition, gastritis may develop into a gastric ulcer.

Chronic gastritis generally lasts for several weeks, months or even years. Constant irritation of the gastric mucosa increases the risk of degeneration and gastric cancer in chronic gastritis. First, the cells of the gastric mucosa transform into intestine-like cells. Then one speaks of intestinal (intestine-related) metaplasia (transformation).

People who have chronic gastritis should therefore undergo gastroscopy regularly every three years. This way, cancer and precancerous lesions can be detected and treated in good time.

Additional information

Books

• Irmgard Fortis diet for gastritis, Maudrich, 2017
• Astrid Laimighofer: Light diet for the stomach and intestines: How to gently build up the diet according to the 3-stage concept Trias 2014
• Heide Steigenberger Irritable stomach: Proper treatment of gastritis, heartburn, stomach depressions and indigestion Kneipp Verlag, 2014
• Gastritis, gastric and duodenal ulcers – Issue 55, Robert Koch Institute, 2013

guidelines

• Helicobacter pylori and gastroduodenal ulcer disease, German Society of Gastroenterology, Digestive and Metabolic Diseases, December 2016