Gastritis

What is?

Gastritis is a morphologically confirmed inflammation of the gastric mucosa, characterized by inflammatory cell infiltration, epithelial damage, and, in some cases, the development of atrophic changes.

It is classified as:

• Acute gastritis — a sudden-onset inflammatory process, often fully reversible;

• Chronic gastritis — a long-standing inflammation with potential progression to atrophy and metaplasia.

Etiology and risk factors

Main causes:

• Helicobacter pylori (H. pylori) — the most common cause of chronic g. (according to Maastricht VI guidelines, >80% of cases);

• Nonsteroidal anti-inflammatory drugs (NSAIDs) — impair mucosal defense through prostaglandin inhibition;

• Alcohol — exerts direct toxic and irritative effects;

• Autoimmune factor — more common in women, associated with pernicious anemia, vitamin B12 deficiency, and antibodies to parietal cells and intrinsic factor;

• Physiological stress (severe trauma, burns, sepsis) — stress-induced acute gastritis;

• Bile reflux (e.g., post-cholecystectomy syndrome).

Risk factors:

• NSAID or glucocorticoid use without gastroprotection;

• Smoking;

• Dietary disorders;

• Chronic alcohol abuse;

• Family history of gastric cancer or autoimmune diseases.

Types and classification of gastritis

Clinical–etiological classification:

Acute:

• Catarrhal

• Erosive (including drug-induced and alcoholic)

• Phlegmonous (rare, bacterial origin)

• Necrotic

Chronic:

• H. pylori–associated

• Autoimmune

• Chemically induced (bile reflux, NSAIDs)

• Idiopathic

Atrophic gastritis — thinning of the mucosa with gland loss and functional impairment.

Clinical manifestations

Disease may be asymptomatic or present with:

• Epigastric pain or discomfort;

• Nausea, early satiety, regurgitation;

• Bloating;

• Loss of appetite;

• In some cases — hematemesis (erosive forms) and melena;

• In autoimmune gastritis — signs of vitamin B12 deficiency anemia (weakness, paresthesia, glossitis).

Diagnosis of gastritis

1. Esophagogastroduodenoscopy (EGD) — the primary diagnostic method allowing mucosal assessment and biopsy;

2. Histological examination (OLGA/OLGIM staging) — confirms inflammation, atrophy, and intestinal metaplasia;

3. H. pylori detection methods:

   • Urea breath test (¹³C or ¹⁴C) — the most sensitive non-invasive test;

   • Stool antigen test (ELISA);

   • Serology (IgG) — less specific, not suitable for eradication assessment;

   • Rapid urease test during EGD;

   • PCR testing from biopsy samples;

4. Complete blood count, vitamin B12, iron, ferritin — when autoimmune gastritis is suspected.

Modern approaches to gastritis treatment

• H. pylori eradication therapy (according to Maastricht VI recommendations);

• Dietary modification with avoidance of irritant foods (fried, spicy foods, alcohol, coffee).

Complications and prevention

Complications:

• Peptic ulcer disease of the stomach and duodenum;

• Gastrointestinal bleeding;

• Pernicious anemia;

• Mucosal dysplasia and gastric cancer (especially in the presence of H. pylori infection and atrophy).

Prevention:

• Eradication of H. pylori when infection is confirmed;

• Avoidance of long-term NSAID use without protective therapy;

• Healthy diet, cessation of alcohol and smoking;

• Endoscopic surveillance in patients with atrophy or intestinal metaplasia.

Gastritis and pregnancy

During pregnancy, gastritis may worsen due to:

• Hormonal changes (elevated progesterone levels slow gastrointestinal motility);

• Displacement of abdominal organs caused by the enlarging uterus.

When to see a doctor

• Persistent or severe epigastric pain;

• Nausea and vomiting, especially with blood;

• Unintentional weight loss, anemia;

• Symptoms of vitamin B12 deficiency;

• History of gastritis and pregnancy planning;

• Hereditary risk of gastric malignancies.

yeranik hambardzumyan
CEO, gastroenterologist, endoscopist

meri soghoyan
gastroenterologist, hepatologist

lucy hovakimyan
gastroenterologist, nutritionist

lilit hakobyan
dietologist, gastroenterologist