Gastritis is an inflammation of the lining of the stomach. There are many
causes of this disorder including an
infection, an irritant, an autoimmune disorder, or a backup of bile into the
stomach. The stomach lining may be "eaten away," leading to sores (peptic
ulcers) in the stomach or first part of the small intestine. Left untreated,
these ulcers may bleed. Gastritis can occur suddenly (acute gastritis) or
gradually (chronic gastritis). In most cases, gastritis does not permanently
damage the stomach lining and sometimes no specific cause of the inflammation is
Signs and Symptoms
The most common symptoms of gastritis are stomach upset and pain. The
following are other symptoms of gastritis.
Indigestion (also called dyspepsia)
Loss of appetite
Vomiting, possibly of blood (called hematemesis) or material that
looks like coffee-grounds
Gastritis can be caused by infection, irritation, autoimmune disorders
(disorders caused by the body's immune response against its own tissues), or
backflow of bile into the stomach (bile reflux). Gastritis can also be caused by
a blood disorder called pernicious anemia.
Infections can be any of the following types:
Bacterial (usually Helicobacter pylori)
Viral (including herpes simplex virus)
Irritation can be caused by a number of things, such as the
Long-term medication use (for example, aspirin, ibuprofen or other
anti-inflammatory drugs [called NSAIDS])
Coffee and acidic beverages
Excess gastric acid secretion (such as from stress)
Eating or drinking caustic or corrosive substances (such as poisons)
Trauma (for example, radiation treatments or having swallowed a
Other causes for gastritis are very rare. These include:
Systemic disease (for example, Crohn's disease)
Infection with H. pylori
Crowded, unsanitary conditions -- this may increase risk of
contracting H. pylori
Acquired immunodeficiency syndrome (AIDS)
Any condition that requires relief from persistent pain using NSAIDS,
such as chronic low back pain, fibromyalgia, or arthritis
There are several tests that may be done to make a diagnosis. These include
endoscopy of the stomach, where a thin tube that has a light and a camera on the
end is inserted down your throat to your stomach. This allows the doctor to see
into your stomach and, if necessary, take samples (called a biopsy) from the
lining. The laboratory tests you may need will depend on the specific cause of
your gastritis. A stool test may be used to check for the presence of blood, or
a biopsy may be taken of the tissues of your esophagus or stomach to determine
the cause of your discomfort. A breath test may detect H. pylori, or samples
from your esophagus or stomach may be taken to look for this
lifestyle changes, such as avoiding the
long-term use of irritants (aspirin, anti-inflammatory drugs, coffee, and
alcohol) will go a long way to preventing gastritis and its complications like
an ulcer. Stress reduction through relaxation techniques including yoga, tai
chi, and meditation can also be quite helpful.
The treatment of gastritis depends on the cause of the problem. Some causes
may resolve by themselves over time, or may be relieved by stopping the
ingestion of irritating substances such as alcohol, tobacco, and aspirin. Some
dietary changes will no doubt be
recommended, although the bland diet often prescribed in the past is no longer
thought to be necessary.
Medications are often necessary to
relieve symptoms, eradicate an infection such as H. pylori, and prevent or treat
complications from gastritis
such as an ulcer.
The cure for gastritis caused by ingesting irritating substances is to stop
the long-term use of these substances, which may include:
Acidic beverages such as coffee (both caffeinated and decaffeinated),
carbonated beverages, and fruit juices with citric acid
NSAIDS, such as aspirin and ibuprofen -
switch to other pain relievers (like acetominophen)
Eat a fiber-rich diet
Avoid high fat foods (at least from animal studies, high fat foods
incresase inflammation in the stomach lining)
Helicobactor pylori infestation, a common bacterial cause of gastritis
and ulcers, is typically treated with a combination of drugs. The typical
combination includes antibiotics, a bismuth compound, and a proton pump
inhibitor. (Proton pump inhibitors reduce stomach acid secretion.) These drugs
are usually taken for at least 14 days.
In addition to the medications used for Helicobacter pylori infection,
other medications that may be used to relieve symptoms of gastritis include
those that reduce stomach acid secretion:
Antacids such as calcium carbonate and magnesium hydroxide with
H2 blockers such as ranitidine, cimetidine, nizatidine, and famotidine
Proton pump inhibitors such as omeprazole and lansoprazole
Drugs that reduce stomach acid secretion help protect against or treat
ulcers. Other drugs used for ulcers include:
Misoprostol - protects against the major
intestinal toxicity of NSAIDS, and can reduce the formation of ulcers
Sucralfate - helps to heal ulcers in the
Nutrition and Dietary Supplements
Eating a diet high in fiber may not only cut your risk of developing ulcers
in half, but fiber-rich foods may also speed the healing of ulcers. Fruits and
vegetables are particularly protective sources of fiber and seem to reduce the
amount of inflammation in the lining of the stomach; fruit juice appears to have
this benefit as well. Plus, if you didn't have enough reasons to avoid fat in
your diet already, animal studies suggest that high fat foods may lead to
Consumption of foods and beverages that irritate the lining of the stomach or
increase the stomach acids should be avoided completely or reduced, and known
allergens eliminated. These often include:
Acidic drinks such as coffee (with and without caffeine)
Spices and peppers (for some people this is important, while for
others such foods do not seem to cause symptoms or inflammation)
Gamma-linolenic acid (GLA)
Very preliminary evidence from test tube and animal studies suggest that
gamma-linolenic acid (GLA) from evening primrose oil (EPO) may have anti-ulcer
properties. GLA is an essential fatty acid (EFA) in the omega-6 family that is
found primarily in plant-based oils, including EPO and borage seed oil. Although
studies are promising, it is too early to know how this might apply to people
Healthy or "friendly" organisms, called probiotics, inhabit the lining of the
intestines and protect us from the entrance of "bad" infections that can cause
disease. Lactobacillus acidophilus (L. acidophilus) is the most
commonly used probiotic. In test tube studies, L. acidophilus and other
probiotics were able to kill or slow down the growth of H. pylori;
research is needed to understand whether that benefit would occur in people. One
way in which probiotics may help is by reducing side effects, such as diarrhea
and taste disturbance, from medications used to treat H. pylori.
People with pernicious anemia and H. pylori infection are deficient in
vitamin B12. Supplementation with this vitamin may be used to treat both. Good
dietary sources of vitamin B12 include fish, dairy products, organ meats
(particularly liver and kidney), eggs, beef, and pork.
The following appear promising, but more research is needed before these
nutrients become a part of treatment for gastritis, its symptoms, or its
Bromelain (Ananas comosus) -- the protein-digesting enzymes
found in bromelain (derived from pineapple) help promote and maintain proper
digestion and may relieve symptoms of stomach upset or heartburn, particularly
when used with other enzymes such as amylase (which digests starch) and lipase
(which digests fat). Studies in people are needed.
Vitamin A - found in many fruits and
vegetables, is thought to increase the benefit of these foods (which are also
rich in fiber as discussed earlier). One study suggests that the combination of
vitamin A and antacids may be more effective than antacids alone in healing
Vitamin C -- in one study, high-dose vitamin C treatment for four
weeks effectively treated H. pylori infection in some, but not all,
people. In addition, H. pylori appears to impair absorption of vitamin C,
which may play a role in the higher risk of stomach cancer for those with this
organism in their gastrointestinal tract.
Herbs may cause side effects or interact with medications. They should,
therefore, be used with caution and only under the guidance of a professionally
trained and qualified herbalist. With that said, there are many herbs, some of
which are described below, that may be recommended by an herbal specialist for
symptoms of gastritis. The herbalist would work with you to individualize your
Astragalus (Astragalus membranaceus) -
used traditionally to treat stomach ulcers. May also prevent the damage from
radiation or chemotherapy that can lead to gastritis.
Barberry (Berberis vulgaris)- This herb contains active
substances called berberine alkaloids. These substances have been shown to
combat infection and bacteria. For this reason, barberry is used to ease
inflammation and infection of the gastrointestinal tract. Barberry has also been
used traditionally to improve appetite.
Bilberry (Vaccinium myrtillus) - Studies in rats have found
that anthocyanidins (an antioxidant) from bilberry fruits help prevent stomach
ulcers caused by a variety of factors including stress, medications, and
alcohol. Whether this will translate into help for people requires research.
Cat's Claw (Uncaria tomentosa) - The
bark and root of this herb have been used among indigenous people of the
rainforest for centuries to treat a variety of health problems including ulcers
and other gastrointestinal disorders. The benefits of this herb may be due to
its ability to reduce inflammation.
Chamomile, Roman (Chamaemelum nobile) - Traditionally, Roman
chamomile has been used to treat nausea, vomiting, heartburn, and excess
Cranberry (Vaccinium spp.) - may have
properties that help prevent H. pylori.
Dandelion (Taraxacum officinale) - Native Americans have
traditionally used dandelion to treat kidney disease, heartburn and stomach
upset, amongst other conditions. Chinese medicinal practitioners traditionally
used dandelion to treat digestive disorders, Today, dandelion roots are
primarily used as an appetite stimulant and digestive aid. If you have
gallbladder disease, you should not use dandelion.
Devil's Claw (Harpagophytum procumbens) - many professional
herbalists consider devil's claw to be useful for upset stomach and loss of
Dong Quai (Angelica sinensis) - animal studies suggest that
dong quai may soothe ulcers, but studies in people are needed before a
definitive conclusion can be drawn.
Ginger (Zingiber officinale) - In
China, ginger has been used to aid digestion and treat stomach upset as well as
nausea for more than 2,000 years. This herb is also thought to reduce
Green Tea (Camellia sinensis) -
Population based studies conducted in Japan suggests that people who drink green
tea regularly may be protecting themselves from developing chronic gastritis.
Licorice (Glycyrrhiza glabra) - this herb is a demulcent
(soothing, coating agent) that has long been valued for its use in food and
medicinal remedies, including treatments for stomach ailments. Some licorice
root extracts, known as deglycyrrhizinated licorice (DGL), still have the
healing properties of licorice without the harmful effects (like high blood
pressure). DGL may be better for stomach or duodenal ulcers and may even be as
effective as some prescription drugs for stomach ulcers.
Slippery elm (Ulmus fulva) - Although there has been little
scientific research on slippery elm, it has a long history of use based on
clinical experience. Gastritis and peptic ulcer are among the conditions that
seem to respond to slippery elm.
Turmeric (Curcuma longa) -Turmeric has long been used in both
Ayurvedic and Chinese medicine to treat digestive disorders. Scientific research
is beginning to test the merit of this traditional use. In an animal study, for
example, extracts of turmeric root reduced the release of acid from the stomach
and protected against injuries such as gastritis or inflammation of the
intestinal walls and ulcers. Further studies are needed to know to what extent
these protective effects apply to people as well. (Note: at very high doses,
turmeric may induce ulcers. It is very important to stick with the dose
recommended by an herbal specialist.)
Yarrow (Achillea millefolium) - Used
traditionally to reduce inflammation, increase appetite, and ease stomach upset.
Animal studies show that certain individual herbal extracts as well as a
combination of these extracts show promise in treating ulcers. The combination
remedy also shows promise for treating dyspepsia (upper abdominal symptoms such
as nausea, loss of appetite, and heartburn). In a study on 137 people with
dyspepsia (indigestion), the combination preparation was as effective as the
drug cisapride (a heartburn medication). More studies are needed before this
combination becomes accepted treatment.
The combination preparation included the following extracts:
Angelica (Angelica archangelica)
German chamomile (Matricaria recutita)
Lemon balm (Melissa officinalis)
Milk thistle (Silybum marianum)
Peppermint (Mentha x piperita)
Although few studies have examined the effectiveness of specific homeopathic
therapies, professional homeopaths may consider the following remedies for the
treatment of gastritis symptoms (such as nausea and vomiting) based on their
knowledge and experience. Before prescribing a remedy, homeopaths take into
account your constitutional type. A constitutional type is defined as your
physical, emotional, and psychological makeup. An experienced homeopath assesses
all of these factors when determining the most appropriate treatment for you
Pulsatilla -- for heartburn, queasiness, a bad taste in the
mouth brought on by eating rich foods and fats (especially ice cream); symptoms
may include vomiting partly digested food; this remedy is most appropriate for
an individual whose tongue is coated with a white or yellow substance
Ipecacuahna -- for persistent and severe nausea, with or
without vomiting and diarrhea, caused by an excess of rich or fatty foods
Carbo vegetabilis -- for bloating and indigestion, especially
with flatulence and fatigue
Nux vomica -- for heartburn, nausea, retching without vomiting,
and sour burps caused by overeating, alcohol use, or coffee drinking; this
remedy is most appropriate for individuals who also feel irritable and sensitive
to noise and light
Acupuncture may be helpful in reducing stress and improving overall digestive
Return to your healthcare provider if your symptoms do not get better or if
they get worse. Do not ignore potentially life-threatening symptoms such as
vomiting blood or blood in your stool. Be aware that you may not see frank blood
in your stool; it may simply look very dark, even black. Be sure to see your
healthcare provider regularly, and call him or her if there is any change in
If you are on both antibiotics and vitamin B12, take them at different times
of day because vitamin B12 interferes with antibiotic absorption.
If you are pregnant or breastfeeding, you should consult with your physician
before taking any medication, including herbs.
Borage seed oil, and possibly other sources of GLA, should not be used during
pregnancy because they may be harmful to the fetus and induce early
Prognosis and Complications
Symptoms of H. pylori infection are usually relieved with treatment, but you
will most likely be asked to see your doctor four weeks or more after stopping
your drug regimen. Follow-up is very important, because the H. pylori bacteria
is linked to stomach cancer.
Peptic ulcers may develop when digestive juices damage the lining of the
stomach or the first part of the small intestine (called the duodenum). These
ulcers can generally be treated effectively with lifestyle changes and
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Review Date: December 2002
Reviewed By: Participants in the review process include: Jacqueline A. Hart, MD,
Department of Internal Medicine, Newton-Wellesley Hospital, Boston, Ma and
Senior Medical Editor A.D.A.M., Inc.;Peter Hinderberger, MD, PhD, Ruscombe
Mansion Community Health Center, Baltimore, MD; Leonard Wisneski, MD, FACP,
George Washington University, Rockville,
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