Gastrite

What is gastritis?

Gastritis is an inflammation of the lining of the stomach. Inflammation is when part of the body becomes hot, red, swollen and painful as a response to injury.

In the stomach, this inflammation can occur in response to a bacteria or as a result of damage to the lining of the stomach (for example, from smoking or alcohol use). Because the stomach needs to produce acid to break down foods, this acid can make the inflammation worse. Therefore, reducing the acid is the main treatment for gastritis.

Many people with gastritis don't have any symptoms. However, gastritis can cause indigestion (dyspepsia) e pain in the upper abdomen just below the breastbone (sternum). The pain usually comes and goes and may be worse on lying down. It may be eased by taking antacid tablets. Sometimes food can make the pain worse.

Other gastritis symptoms which may occur include:

• Perda de apetite.

• Inchaço.

• Retching.

• Enjoo (náusea).

• Vomitar (vômito).

• Feeling particularly 'full' after a meal.

Symptoms of gastritis may start suddenly and resolve quickly (acute gastritis) or may develop slowly and last for a long period of time (chronic gastritis).

Don't assume that pain in the upper abdomen is always a sign of gastritis - the pain could be caused by a wide range of other things, such as a non-ulcer dyspepsia, úlcera duodenal, úlcera estomacal, cálculos biliares ou síndrome do intestino irritável. See the separate leaflet called Abdominal pain.

The length of symptoms can vary depending on the cause and how actively it is managed, either by lifestyle change or medicine or a combination of both.

The stomach normally produces acid to help with the digestion of food in your digestive tract and to kill bacteria.

This acid is corrosive so some cells on the inside lining of the stomach produce a natural mucous barrier. This protects the lining of the stomach and the first part of the small intestine (the duodenum).

There is normally a balance between the amount of acid being made and the mucous defence barrier. Gastritis may develop if there is an alteration in this balance, allowing the acid to damage the lining of the stomach. This alteration can be caused by:

Infection with Helicobacter pylori

Infection with Helicobacter pylori is present in about 6 in 10 cases of chronic gastritis. The test for this is via a simple stool test. Worldwide more than 2 in 3 people have H. pylori and it is found in around 4 in 10 people in the UK. As it is so common, it is not certain that H. pylori is the cause of the symptoms in all people with gastritis and H. pylori. See the separate leaflet called Helicobacter pylori for more information.

Medicamentos anti-inflamatórios

Medicamentos anti-inflamatórios are sometimes called NSAIDs. Many people take an anti-inflammatory medicine for joint inflammation (arthritis), muscular pains, etc.

These medicines sometimes affect the mucous barrier of the stomach and allow acid to cause inflammation or an ulcer.

Fumar

Smoking is a common cause of gastritis. It also increases the risk of stomach cancer.

Other causes of gastritis

Less common causes of gastritis include:

• A stressful event - such as a bad injury or critical illness, or major surgery.

• An autoimmune reaction - when the immune system mistakenly attacks the body's own cells and tissues. (This may happen alongside have another autoimmune condition, such as Hashimoto's thyroid disease or diabetes tipo 1).

• Uso de cocaína.

• Beber muito álcool.

• Viruses, parasites, fungi and bacteria other than H. pylori.

A GP can usually make a diagnosis of gastritis by taking a history of the symptoms and an examination of the abdomen. Mild gastritis does not usually need any tests.

If gastritis doesn't get better quickly, or causes severe pain, then the GP may arrange some tests. These tests may include:

• Exames de sangue, including a test for anaemia, as gastritis occasionally causes some bleeding from your stomach lining.

• A test to detect the Helicobacter pylori bacteria. H. pylori can be detected in a stool test (faeces), or from a biopsy sample taken during an endoscopy. See the separate leaflet called Helicobacter pylori for more details.

• Gastroscopia (endoscopia) - this test can confirm gastritis. In this test a clinician looks inside the stomach by passing a thin, flexible telescope down the gullet (oesophagus). Small samples (biopsies) are usually taken of the stomach lining during endoscopy. These are sent to the laboratory to be looked at under the microscope. This also checks for stomach cancer.

Mudanças no estilo de vida

It is sensible to try treating indigestion and upper stomach (epigastric) pain with changes to diet and lifestyle such as:

• Eating smaller and more frequent meals.

• Avoiding irritating foods, such as spicy, acidic (for example, fruit juices), fried or fatty foods.

• Not drinking any alcohol.

• Parar de fumar.

• Reducing stress.

• Stopping anti-inflamatórios não esteroides (AINEs) and switching to a different painkiller if needed, such as paracetamol.

Acid-suppressing medicine

• Antiácidos can be used as a treatment for gastritis to reduce the amount of acid in your stomach and allow the gastritis resolve.

• If treatment with antacid medicine is not enough, then a medicine called an H2 blocker (such as famotidine) may be used.

• An alternative medicine that may be used is a inibidor da bomba de prótons (IBP) como lansoprazol ou omeprazol.

See the separate leaflet called Indigestion medicine for more information.

If the gastritis is caused by Helicobacter pylori (H. pylori)

The tests may show an infection with H. pylori. This can be treated with a combination of antibiotics and proton pump inhibitors. H. pylori treatment should not be used without confirmed H. pylori on a stool test. See the separate leaflet called Helicobacter pylori for more details about the treatment for H. pylori infection.

If the gastritis is caused by an anti-inflammatory medicine

It is important to stop the anti-inflammatory medicine where possible. This allows the gastritis to heal. Acid-suppressing medicine will also usually be prescribed for several weeks. This stops the stomach from making acid and allows the gastritis to heal.

It may not always be possible to stop the medicine. Aspirin will often be needed, for example following a heart attack or stroke. Anti-inflammatory medicine may occasionally be the only medicine suitable for pain.

It is important to discuss symptoms of gastritis with a doctor if it could be caused by medicine as there may be alternative medicines that could help. If not, another option is to take an acid-suppressing medicine each day indefinitely. This reduces the amount of acid made by the stomach and greatly reduces the chance of gastritis forming again.

Seek medical attention if there is:

• Severe abdominal pain.

• Abdominal pain or any other indigestion symptoms lasting for more than a week.

• The gastritis starts after taking any medicine (prescription or over-the-counter).

• Weight loss without deliberately trying to diet.

• Difficulty swallowing, as if food is getting stuck.

Gastritis usually resolves without any complications. Very occasionally gastritis may develop into a úlcera estomacal. This used to be more common but is less so nowadays with newer better treatments.

Bleeding from the stomach lining may occur. This may cause vomiting of blood (haematemesis)or blood in the stools (often dark black tarry blood). If the bleeding is slow, there may be no obvious symptoms but a blood test may show anaemia.

Can gastritis cause heartburn?

Gastritis can cause a burning sensation similar to heartburn, but it differs from acid reflux. The symptoms are caused by stomach lining inflammation rather than acid reflux into the oesophagus.

Can you cure gastritis permanently​?

Gastritis can often be managed or cured depending on the cause. H. pylori infections can be treated with antibiotics, whilst lifestyle-related gastritis may require lasting changes such as stopping smoking and long-term use of certain medicines. Some cases may need ongoing management to prevent recurrence.

Will gastritis kill you?

Gastritis itself is not life-threatening and can be managed with lifestyle changes and medicine. However, if left untreated, it can lead to complications such as stomach ulcers or bleeding, which can be more serious and even fatal.

Is gastritis contagious?

Most cases of gastritis are not contagious and cannot be passed on to other people. Whilst the H. pylori bacteria can spread between people in rare cases, simple stomach irritation from lifestyle or medicines cannot be passed on.