Digestive Disorders > Upper Abdomen

What helps against gastritis?

Dr. med. Andre Sommer

Dr. med. Andre Sommer

Gastritis is composed of the word "gaster" (Greek for stomach) and the ending "itis" (inflammation). More precisely, it stands for gastric mucosal inflammation. It is an inflammation of the skin that lines the stomach and protects the stomach wall from acid. Stress and nutrition often play a critical role here. What is the difference between gastric mucosal inflammation and irritable stomach? What treatment options and medications are there? What are the causes of gastritis? What really helps against inflammation of the mucous membrane? Find out more in this text.

How is gastritis classified?

Gastritis is divided on the one hand according to its course and on the other hand according to its origin. Thus there is a differentiation between acute and chronic gastritis. Chronic gastritis is divided into Type A, Type B and Type C gastritis. In some divisions, Type D is added for various other causes and Type R is for gastritis due to reflux disease.

How does acute gastritis develop?

With acute gastritis the symptoms suddenly appear and disappear after a few days **mostly on their own. The causes of acute gastritis can be varied, and commonly involve **virus or bacteria. Excess alcohol or food can also irritate the gastric mucosa and cause typical symptoms like epigastric pain, feeling of fullness and nausea. Acute gastritis may also develop into chronic inflammation.

How does chronic type A gastritis develop?

Type A gastritis involves an autoimmune disease. The body's immune cells mistakenly recognize the parietal cells as "hostile" structures and attack them. The result is the downfall of these cells and thus the production of stomach acid and the intrinsic factor._ _The lack of stomach acid is called achlorhydria. The destruction of the cells also leads to atrophy of the gastric mucosa. The rising pH in the stomach also stimulates the secretion of the gastrin hormone. This can even contribute to the development of malignant diseases.

Due to the lack of intrinsic factor less vitamin B12 is also taken up in the small intestine through the mucous membrane into the blood. Since this substance is important in the blood metabolism, it can lead to anemia with few but too large red blood cells - so-called pernicious anemia. If the vitamin deficiency is not recognized and compensated for in good time, even a spinal cord disease, funicular myelosis, can develop, in which those affected develop sensitivity disorders, for example in the form of tingling in the legs. Overall, autoimmune gastritis is rather rare and only makes up about five percent of all chronic gastritis.

How does chronic type B gastritis develop?

Type B gastritis involves the bacterium Helicobacter pylori. While gastric acid makes most bacteria harmless, this pathogen has adapted to the environment and defies the low pH by nesting in the lining of the stomach and producing ammonia there, which raises the pH in its immediate vicinity. The bacteria can be detected in the stomach in almost every second person, but not everyone suffers from gastric mucosal inflammation. Nevertheless, the search for H. pylori is indispensable for digestive problems, since the germ is also the main cause of gastric ulcers and can even promote stomach cancer and lymphatic cancer. Various mechanisms leading to damage to the mucous membrane are assumed. In particular, the increased ammonia production and the release of cell toxins are blamed for the problems. About 85 percent of gastric mucosal infections are caused by Helicobacter bacteria.

How does chronic type C gastritis develop?

Various chemical substances can trigger type C gastritis. Common causes are painkillers, especially the non-steroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen, acetylsalicylic acid or diclofenac). These drugs inhibit enzymes that normally produce pain and fever mediators. At the same time, however, protective mechanisms of the stomach, such as mucus production, are inhibited so that the stomach acid can attack the mucous membrane. The effect increases if, at the same time as the pain reliever, glucocorticoids (also called steroids) are taken - the result can be stomach ulcers with a high risk of bleeding. This occurs, for example, in the treatment of rheumatoid arthritis by using the combination of medications mentioned above.

Also antibiotics can cause type C gastritis, as can food poisoning and fungi, acids, bases, alcohol or smoking. A special form of type C gastritis arises when part of the stomach and thus the head of the stomach (pylorus) has had to be removed and bile juice can run into the stomach unhindered. The bile acids irritate the mucous membrane and also lead to inflammation.

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How does gastritis manifest itself?

Many cases of gastritis show no or only subtle symptoms in the digestive system and are only detected accidentally during gastroscopy. Type A gastritis, for example, is more noticeable due to anemia or sensitivity disorders that can arise as a result of vitamin B12 deficiency. If Helicobacter pylori is involved, bad breath and unspecific upper abdominal pain may occur. Type B and type C gastritis often only become clinically noticeable when a gastric ulcer develops. In a weakened form, chronic gastritis can also show the symptoms of acute gastritis. This includes abdominal pain, feeling of fullness, loss of appetite, nausea, diarrhea and vomiting. A typical occurrence with gastritis abdominal pain is a temporary improvement after eating. If the mucous membrane is severely affected or ulcers already exist, bleeding may also occur, which may show up as black-colored tar stool, vomiting blood or also anemia. This bleeding anemia is different from vitamin B12 deficiency anemia. In this case, not only is the number of red blood cells reduced, but they are themselves too small.

How is gastritis diagnosed?

Acute gastritis usually heals within a few days and due to the clinical symptoms it can be reasonably, if not clearly, diagnosed without aids. The classic detection method for chronic gastritis is gastroscopy (esophagogastroduodenoscopy, EGD or gastroscopy). A camera is inserted into the stomach through a tube (endoscope) and the mucous membrane is examined. In addition, tissue samples can be removed, which can then be examined under the microscope for signs of inflammation. Helicobacter can also be detected using this method. In addition, there are also quick and breath tests. Since the stomach is in close proximity to the heart, heart problems such as a heart attack or angina pectoris should also be excluded in the case of supposed stomach pain.

How is gastritis treated?

The treatment of gastritis depends on the suspected trigger and the distress of the person concerned. For example, if inflammation is found accidentally during gastroscopy, treatment is rarely necessary. Treatment of acute gastritis is usually limited to symptomatic therapy - It is recommended that the person affected eat small meals that are gentle on the stomach and avoid alcohol, coffee and nicotine.

If Helicobacter bacteria are detected during gastroscopy and there are complaints or an increased risk of stomach ulcers and stomach cancer, eradication therapy can be used. This consists of proton pump inhibitors and two antibiotics (usually clarithromycin plus metronidazole or amoxicillin) together and is carried out over seven days. The success of the therapy must be checked after about two months by a new gastroscopy or a breath test.

Since no causal therapy has been possible for autoimmune gastritis, substitution of vitamin B12 is in the foreground. If H. pylori has also been detected, eradication therapy may bring the disease to a cure. If gastritis is caused by chemical substances, the triggering drug must be discontinued or the chemical avoided if possible - if this is not possible, proton pump inhibitors can be used. If gastritis is due to biliary reflux after surgery, surgical correction can be discussed.

Is irritable stomach the same as gastritis?

If the symptoms of gastritis exist, but inflammation cannot be determined endoscopically, it may be so-called irritable stomach syndrome, including functional dyspepsia. Like the better known irritable bowel syndrome, it is an exclusion diagnosis - All other possible causes must therefore be excluded before this diagnosis is made. Various causes are suspected to trigger the irritable stomach, including increased awareness of pain or decreased stomach movement (peristalsis), that leads to delayed gastric emptying. The symptoms are also often caused by

  • Fast consumption of large portions
  • Lack of exercise
  • Stress
  • Coffee
  • Alcohol and
  • Smoke.

Also lack of sleep can contribute to the development and maintenance of symptoms. The symptoms should not, however, make those affected wake up from sleep; bleeding from the gastrointestinal tract also suggests other diagnoses. Even if the disease is harmless and does not cause any complications, it can greatly reduce the quality of life for those affected. Proton pump inhibitors and antibiotic therapy can alleviate the symptoms with the detection of Helicobacter pylori. However, the most important measure is adaptation of the lifestyle. Among other things, this means taking more time to eat and eating smaller portions throughout the day. In addition, bloating foods should be avoided and sufficient liquid should be drunk. Regular exercise and a good sleep routine can also relieve the discomfort. Avoid alcohol, coffee and cigarette smoking.

What is gastritis?

The term gastritis refers to an inflammation of the stomach lining. As a digestive organ, the stomach is lined with a certain surface tissue called the mucous membrane or mucosa. The tissue is composed of different cells, each with specific tasks. The main cells produce precursors to the digestive enzymes (Pepsinogens), which are then activated in the duodenum. The parietal cells produce hydrochloric acid, which helps break down food and can kill bacteria. In addition, these cells release the intrinsic factor, which is essential for the absorption of vitamin B12 in the small intestine. So that the gastric mucosa is not attacked by the stomach acid it produces, the secondary cells are responsible for the production of basic mucus, which lies over the stomach mucosa and thus protects it. A smaller population of cells is responsible for histamine production. Histamine has a stimulating effect on gastric acid production.

Since the stomach is an access path for bacteria in the body, there are many lymph channels and immune cell nests in its environment and also directly in the stomach wall. This ensures that invading pathogens can be quickly identified and combated. However, this also means that the stomach is often the site of these "struggles" and the gastric mucosa can be inflamed by the activation of the immune cells.

Gerd Herold and staff: Innere Medizin, Gerd Herold Köln, 2011, S.431ff
S2k-Leitlinie Helicobacter pylori und gastroduodenale Ulkuskrankheit. 2016, http://www.awmf.org/uploads/txszleitlinien/021-001lS2kHelicobacter-pylori-gastroduodenaleUlkuskrankheit2016-0401.pdf, 20.07.2016
Reinhard Bornemann, Elisabeth Gaber. “Themenheft 55 - Gastritis, Magen-und Zwölffingerdarmgeschwür" Robert-Koch-Institut, Gesundheitsberichterstattung, 2013, http://edoc.rki.de/documents/rki_fv/reeWxNCWu0CEQ/PDF/24hFaa47lI2fg.pdf, 20.07.2016
Michael Camilleri: "Functional Dyspepsia and Gastroparesis." Digestive Diseases 34.5 /2016, p. 491-499.
Hershel Jick et al.: “Risk of upper gastrointestinal bleeding and perforation associated with individual non-steroidal anti-inflammatory drugs”, The Lancet,343.8900/1994, p. 769-772.
James W. Varni et al.: “Symptom Profiles in Patients With Irritable Bowel Syndrome or Functional Abdominal Pain Compared With Healthy Controls”, Journal of pediatric gastroenterology and nutrition, 61.3/2015, p. 323-329.

Dr. med. Andre Sommer

Dr. med. Andre Sommer

I’m André, a medical doctor from Berlin. Together with a team of medical doctors, nutritionists and data scientists we empower people to understand digestive issues with our app Cara.

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