1. What is gastritis?
Gastritis is a morphologically confirmed inflammation of the gastric mucosa, characterized by infiltration with inflammatory cells, epithelial damage, and in some cases, atrophic changes.
There are two main types:
- Acute gastritis – sudden onset inflammation, often reversible;
- Chronic gastritis – a long-standing inflammatory process that may lead to atrophy and metaplasia.
2. Etiology and risk factors of gastritis
Primary causes:
· Helicobacter pylori (H. pylori) — the most common cause of chronic gastritis (according to Maastricht VI guidelines, responsible for >80% of cases);
· Nonsteroidal anti-inflammatory drugs (NSAIDs) — disrupt the protective mucosal barrier by inhibiting prostaglandins;
· Alcohol — exerts direct toxic and irritative effects;
· Autoimmune gastritis — predominantly affects women; associated with pernicious anemia, vitamin B12 deficiency, and antibodies to parietal cells and intrinsic factor;
· Physiological stress (e.g., severe trauma, burns, sepsis): stress-induced acute gastritis;
· Bile reflux (e.g., in postcholecystectomy syndrome).
Risk factors:
· NSAID or glucocorticoid use without gastroprotection
· Smoking
· Poor dietary habits
· Chronic alcoholism
· Family history of gastric cancer or autoimmune disorders
3. Types and classification of gastritis
Clinical-etiological classification:
Acute gastritis:
· Catarrhal
· Erosive (including drug-induced or alcohol-related)
· Phlegmonous (rare, bacterial)
· Necrotic
Chronic gastritis:
· H. pylori-associated
· Autoimmune
· Chemically induced (e.g., bile reflux, NSAIDs)
· Idiopathic
· Atrophic gastritis — characterized by mucosal thinning, gland loss, and functional insufficiency
4. Clinical manifestations
Gastritis may be asymptomatic or present with the following complaints:
· Epigastric pain or discomfort
· Nausea, belching, early satiety
· Bloating
· Loss of appetite
· In some cases — hematemesis (in erosive forms), melena
· In autoimmune gastritis — signs of B12-deficiency anemia: fatigue, paresthesia, glossitis
5. Diagnosis of gastritis
1. Esophagogastroduodenoscopy (EGD) — gold standard for diagnosis; allows direct visualization of mucosa and biopsy sampling
2. Histological examination (using OLGA/OLGIM classifications) — confirms inflammation, atrophy, or intestinal metaplasia
3. H. pylori testing:
Urea breath test (¹³C or ¹⁴C) — most sensitive non-invasive method
Stool antigen test (ELISA)
Serology (IgG) — less specific, not suitable for confirming eradication
Rapid urease test on biopsy specimen
PCR for H. pylori in biopsy samples
4. CBC, vitamin B12, iron, ferritin — if autoimmune gastritis is suspected
5. pH-metry and Schilling test — in specific clinical situations
6. Modern approaches to treatment
· H. pylori eradication therapy (according to Maastricht VI)
· Diet avoiding irritant foods (fried, spicy, alcohol, coffee, etc.)
7. Complications and prevention
Complications:
· Peptic ulcer disease of the stomach and duodenum
· Gastrointestinal bleeding
· Pernicious anemia
· Mucosal dysplasia and gastric cancer (especially in H. pylori infection with atrophy)
Prevention:
· Eradication of H. pylori when infection is confirmed
· Avoiding long-term NSAID use without protective therapy
· Healthy diet, alcohol and smoking cessation
· Endoscopic surveillance in patients with atrophy or intestinal metaplasia
8. Gastritis and pregnancy
During pregnancy, gastritis may worsen due to:
· Hormonal changes (elevated progesterone slows gastrointestinal motility)
· Organ displacement caused by the growing uterus
9. When to see a doctor
· Persistent or severe epigastric pain
· Nausea and vomiting, especially with blood
· Weight loss, anemia
· Symptoms of vitamin B12 deficiency
· History of gastritis and planning pregnancy
· Family history of gastric cancer