Gastritis

The most common symptoms of gastritis are stomach upset and pain. Other possible symptoms include:

• Indigestion (dyspepsia)
• Heartburn
• Abdominal pain
• Hiccups
• Loss of appetite
• Nausea
• Vomiting, possibly of blood or material that looks like coffee grounds
• Dark stools

Gastritis can be caused by infection, irritation, autoimmune disorders (where the body's immune system mistakenly attacks the stomach), or backflow of bile into the stomach (bile reflux). Gastritis can also be caused by a blood disorder called pernicious anemia.

Infections can be caused by:

• Bacteria (usually Helicobacter pylori)
• Virus (including herpes simplex virus)
• Parasite
• Fungus

A number of things can cause irritation, including:

• Long-term use of NSAIDs, such as ibuprofen (Advil, Motrin) or naproxen (Aleve). Up to 20% of people who chronically use NSAIDs develop gastric problems.
• Alcohol use
• Cigarette smoking
• Chronic vomiting
• Coffee and acidic beverages
• Too much stomach acid (such as from stress)
• Eating or drinking caustic or corrosive substances (such as poisons)
• Trauma (for example, radiation treatments or having swallowed a foreign object)

Other causes for gastritis are very rare. These include:

• Systemic disease (for example, Crohn disease)
• Sarcoidosis

• Infection with H. pylori
• Acquired immunodeficiency syndrome (AIDS)
• Any condition that requires relief from chronic pain using NSAIDS, such as chronic low back pain, fibromyalgia, or arthritis
• Alcoholism
• Cigarette smoking
• Older age
• Herpes simplex virus or cytomegalovirus
• Inflammatory bowel disease

Several tests can be used to make a diagnosis. These include endoscopy of the stomach, where a thin tube with a light and a camera on the end is inserted down your throat into your stomach. This allows the doctor to see into your stomach and take samples (called a biopsy) from the lining if needed. The laboratory tests you may need will depend on the cause of your gastritis. Your doctor may use a stool test to check for the presence of blood, or your doctor may take a sample of tissue, called a biopsy, from your esophagus or stomach. A breath test or a biopsy may detect H. pylori.

Making lifestyle changes, such as avoiding the long-term use of alcohol, NSAIDs, coffee, and drugs, may help prevent gastritis and its complications (such as a peptic ulcer). Reducing stress through relaxation techniques, including yoga, tai chi, and meditation, can also be helpful.

Treatment of gastritis depends on the cause of the problem. Some cases of gastritis may resolve by themselves over time, or be relieved when you stop drinking alcohol, smoking cigarettes, or taking NSAIDs. You may need to change your diet, although doctors now know that a bland diet is not required. If your gastritis is due to H. pylori infection, your doctor will prescribe antibiotics.

Lifestyle

The treatment for gastritis that is caused by irritants is to stop using them. These include:

• Alcohol
• Tobacco
• 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 acetaminophen).

These steps may also help:

• Eat a fiber-rich diet.
• Foods containing flavonoids like apples, celery, cranberries (including cranberry juice), onions, garlic, and tea may stop the growth of H. pylori.
• Avoid high-fat foods. In animal studies, high-fat foods increase inflammation in the stomach lining.

Medications

If you have H. pylori, you will probably be prescribed three medications. Doctors commonly use "triple therapy," to treat H. pylori-related gastritis and ulcers, including a proton pump inhibitor to reduce acid production and two antibiotics. Bismuth salicylate (Pepto Bismol) may be used instead of the second antibiotic. This drug, available over the counter, coats and soothes the stomach, protecting it from the damaging effects of acid.

Some of the same drugs used for non-H. pylori gastritis as are used for symptoms (like indigestion) due to ulcers:

Antacids

Available over the counter, they may relieve heartburn or indigestion but will not treat an ulcer. Antacids may block medications from being absorbed and thereby decrease the medicine's effectiveness. Doctors recommend taking antacids at least 1 hour before or 2 hours after taking medications. Ask your pharmacist or doctor for more information. Antacids include:

• Aluminum hydroxide (Amphojel, AlternaGEL)
• Magnesium hydroxide (Phillips' Milk of Magnesia)
• Aluminum hydroxide and magnesium hydroxide (Maalox, Mylanta)
• Calcium carbonate (Rolaids, Titralac, Tums)
• Sodium bicarbonate (Alka-Seltzer)

H2 blockers

Reduce gastric acid secretion. They include:

• Cimetidine (Tagamet)
• Ranitidine (Zantac)
• Nizatidine (Axid)
• Famotidine (Pepcid)

Proton pump inhibitors

Decrease gastric acid production. They include:

• Esomeprazole (Nexium)
• Lansoprazole (Prevacid)
• Omeprazole (Prilosec)
• Pantoprazole (Protonix)
• Rabeprazole (AcipHex)

Nutrition and Dietary Supplements

Doctors used to recommend eating bland foods with milk and only small amounts of food with each meal. Researchers now know that such a diet is not required to treat gastritis or ulcers.

Following these nutritional tips may help reduce symptoms:

• Foods containing flavonoids, like apples, celery, cranberries (including cranberry juice), onions, garlic, and tea may inhibit the growth of H. pylori.
• Eat antioxidant-rich foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell peppers).
• Eat foods high in B vitamins and calcium, such as almonds, beans, whole grains (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables.
• Avoid refined foods, such as white breads, pastas, and sugar.
• Eat lean meats, cold-water fish, tofu (soy, if no allergy) or beans for protein.
• Use healthy oils, such as olive oil.
• Reduce or eliminate trans fatty acids, found in commercially-baked goods, such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid beverages that may irritate the stomach lining or increase acid production including coffee (with or without caffeine), alcohol, and carbonated beverages.
• Drink 6 to 8 glasses of filtered water daily.
• Exercise at least 30 minutes daily, 5 days a week.
• Identify and eliminate food allergies.

The following supplements may help with digestive health:

• A multivitamin daily, containing the antioxidant vitamins A, C, E, the B vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium.
• Omega-3 fatty acids, such as fish oil, may help decrease inflammation. Fish oil may increase the risk of bleeding. If you take aspirin or other anticoagulants (blood thinners), talk to your doctor before taking fish oil.
• Probiotic supplement (containing Lactobacillus acidophilus). Probiotics or "friendly" bacteria may help maintain a balance in the digestive system between good and harmful bacteria, such as H. pylori. Probiotics may help suppress H. pylori infection, and may also help reduce side effects from taking antibiotics, the treatment for an H. pylori infection. Some probiotic supplements need to be refrigerated for best results. People who have weakened immune systems, or who are taking immune-suppressive drugs, should take probiotics only under the direction of their physician.
• Vitamin C. Studies show that pharmacological doses of vitamin C may improve the effectiveness of H. pylori-eradication therapy. Speak with your physician about what dose might be appropriate for you.

Herbs

Herbs may strengthen and tone the body's systems. As with any therapy, you should work with your health care provider before starting any treatment. You may use herbs as dried extracts (capsules, powders, or teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Herbs can interact with medications or other supplements, and some herbs may not be appropriate for people with certain medical conditions. Work with a knowledgeable herbal prescriber and keep all of your medical providers informed of any herbs or supplements you are considering. Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. You may use tinctures alone or in combination as noted.

• Cranberry (Vaccinium macrocarpon). Some preliminary research suggests cranberry may inhibit H. pylori growth in the stomach. Avoid cranberry extract if you have an aspirin allergy. Cranberry may increase the risk of bleeding in people who take blood-thinning medications, such as warfarin (Coumadin) or aspirin, among others. Cranberry may decrease the speed at which your body processes certain medications and therefore increase the amount of those medications in your bloodstream at a given time. Speak with your doctor if you have concerns.
• Mastic (Pistacia lentiscus) standardized extract. Mastic is a traditional treatment for peptic ulcers and inhibits H. pylori in test tubes. More studies are needed to see whether it works in humans.
• DGL-licorice (Glycyrrhiza glabra) standardized extract, chewed either 1 hour before, or 2 hours after meals, may help protect against stomach damage from NSAIDs. Glycyrrhizin is a chemical found in licorice that causes side effects and drug interactions. DGL is deglycyrrhizinated licorice, or licorice with the glycyrrhizin removed. Take medications at least 1 hour before or after taking DGL.
• Peppermint (Mentha piperita). May help relieve symptoms of peptic ulcer. Each tablet contains 0.2 ml peppermint oil. Be sure to use the enteric coated form to avoid heartburn. Peppermint can potentially interact with a variety of medications, and it can be toxic at high doses. Speak with your physician.

Homeopathy

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 constitution, includes your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment.

• 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 someone whose tongue is coated with a white or yellow substance.
• Ipecacuanha. 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 people who also feel irritable and sensitive to noise and light.

Acupuncture

Acupuncture may help reduce stress and improve overall digestive function.

Go back to your doctor 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. Blood in the stool can be hard to see. The stools may simply look very dark, even black. Be sure to see your health care provider regularly, and call your doctor if there is any change in your symptoms.

If you are on both antibiotics and vitamin B12, take them at different times of day. Vitamin B12 interferes with antibiotic absorption.

Pregnancy

If you are pregnant or breastfeeding, you should ask your doctor before taking any medication, including herbs.

Prognosis and Complications

Symptoms of H. pylori infection usually get better with treatment. Your doctor will likely want to see you again 4 weeks or more after stopping your drug regimen. Follow up is very important because the H. pylori bacteria may increase risk of stomach cancer.

Peptic ulcers may develop when stomach acid damages the lining of the stomach or the first part of the small intestine (called the duodenum). These ulcers can usually be treated with lifestyle changes and medication.

Aditi A, Graham DY. Vitamin C, gastritis, and gastric disease: a historical review and update. Dig Dis Sci. 2012;57(10):2504-15.

Aly AM, Al-Alousi L, Salem HA. Licorice: a possible anti-inflammatory and anti-ulcer drug. AAPS PharmSciTech. 2005;6(1):E74-E82.

Bujanda L. The effects of alcohol consumption upon the gastrointestinal tract. Am J Gastroenterol. 2000;95(12):3374-82.

Burger O, Ofek I, Tabak M, Weiss EI, Sharon N, Neeman I. A high molecular mass constituent of cranberry juice inhibits helicobacter pylori adhesion to human gastric mucus. FEMS Immunol Med Microbiol. 2000;29(4):295-301.

Burger O, Weiss E, Sharon N, Tabak M, Neeman I, Ofek I. Inhibition of Helicobacter pylori adhesion to human gastric mucus by a high-molecular-weight constituent of cranberry juice. Crit Rev Food Sci Nutr. 2002;42(3 Suppl):279-84.

Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea--a review. J Am Coll Nutr. 2006;25(2):79-99.

Cremonini F, Di Caro S, Covino M, et al. Effect of different probiotic preparations on anti-helicobacter pylori therapy-related side effects: a parallel group, triple blind, placebo-controlled study. Am J Gastroenterol. 2002;97(11):2744-9.

Cwikla C, Schmidt K, Matthias A, Bone KM, Lehmann R, Tiralongo E. Investigations into the antibacterial activities of phytotherapeutics against Helicobacter pylori and Campylobacter jejuni. Phytother Res. 2010;24(5):649-56.

El-Serag HB, Satia JA, Rabeneck L. Dietary intake and the risk of gastro-oesophageal reflux disease: a cross sectional study in volunteers. Gut. 2005;54(1):11-17.

Ferri FF. Ferri's Clinical Advisor 2016. 1st ed. Philadelphia, PA: Elsevier; 2016.

Fisher WE. The digestive system. In: Bope ET, Kellerman RD, eds. Conn's Current Therapy 2014. Philadelphia, PA: Elsevier Saunders; 2012:483-571.

Fox M, Barr C, Nolan S, Lomer M, Anggiansah A, Wong T. The effects of dietary fat and calorie density on esophageal acid exposure and reflux symptoms. Clin Gastroenterol Hepatol. 2007;5(4):439-44.

Genta RM, Sonnenberg A. Helicobacter-negative gastritis: a distinct entity unrelated to Helicobacter pylori infection. Aliment Pharmacol Ther. 2014;41(2):218-26.

Gorbach SL. Probiotics in the third millennium. Dig Liver Dis. 2002;34(Suppl 2):S2-S7.

Han KS. The effect of an integrated stress management program on the psychologic and physiologic stress reactions of peptic ulcer in Korea. J Holist Nurs. 2002;20(1):61-80.

Hong SN, Jo S, Jang JH, et al. Clinical characteristics and the expression profiles of inflammatory cytokines/cytokine regulatory factors in asymptomatic patients with nodular gastritis. Dig Dis Sci. 2012;57(6):1486-95.

Kaptan K, Beyan C, Ural AU, et al. Helicobacter pylori -- is it a novel causative agent in vitamin B12 deficiency? Arch Intern Med. 2000;160(9):1349-53.

Khayyal MT, el-Ghazaly MA, Kenawy SA, et al. Antiulcerogenic effect of some gastrointestinally acting plant extracts and their combination. Arzneimittelforschung. 2001;51(7):545-53.

Kim DC, Kim SH, Choi BH, Baek NI, Kim D, Kim MJ, Kim KT. Curcuma longa extract protects against gastric ulcers by blocking H2 histamine receptors. Biol Pharm Bull. 2005;28(12):2220-4.

Klausz G, Tiszai A, Lenart Z, et al., Helicobacter pylori-induced immunological responses in patients with duodenal ulcer and in patients with cardiomyopathies. Acta Microbiol Immunol Hung. 2004;51(3):311-20.

Marteau P, Boutron-Ruault MC. Nutritional advantages of probiotics and prebiotics. Br J Nutr. 2002;87(Suppl 2):S153-7.

Marteau PR. Probiotics in clinical conditions. Clin Rev Allergy Immunol. 2002;22(3):255-73.

Martin B. Prevention of gastrointestinal complications in the critically ill patient. AACN Adv Crit Care. 2007;18(2):158-66.

Hess JM, Lowell MJ. Esophagus, stomach, and duodenum. In: Marx JA, Hockberger RS, Walls RM, eds. Rosen's Emergency Medicine. 7th ed. Philadelphia, PA: Elsevier Mosby; 2009:1170-85.

Matsushima M, Suzuki T, Masui A, et al. Growth inhibitory action of cranberry on Helicobacter pylori. J Gastroenterol Hepatol. 2008;23(Suppl 2):S175-80.

McManus TJ. Helicobacter pylori: an emerging infectious disease. Nurs Pract. 2000;25(8):42-6.

Olafsson S, Berstad A. Changes in food tolerance and lifestyle after eradication of Helicobacter pylori. Scand J Gastroenterol. 2003;38(3):268-76.

Paraschos S, Magiatis P, Mitakou S, et al., In vitro and in vivo activities of Chios mastic gum extracts and constituents against Helicobacter pylori. Antimicrob Agents Chemother. 2007;51(2):551-9.

Qasim A, O'Morain CA. Review article: treatment of Helicobacter pylori infection and factors influencing eradication. Aliment Pharmacol Ther. 2002;16(Suppl 1):24-30.

Rosch W, Vinson B, Sassin I. A randomised clinical trial comparing the efficacy of a herbal preparation STW 5 with the prokinetic drug cisapride in patients with dysmotility type of functional dyspepsia. Z Gastroenterol. 2002;40(6):401-8.

Shibata K, Mariyama M, Fukushima T, Kaetsu A, Miyazaki M, Une H. Green tea consumption and chronic atrophic gastritis: a cross-sectional study in a green tea production village. J Epidemiol. 2000;10(5):310-6.

Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr. 2002;21(6):495-505.

Sonnenberg A, Melton SD, Genta RM. Frequent occurrence of gastritis and duodenitis in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2011;17(1):39-44.

Stoicov C, Saffari R, Houghton J. Green tea inhibits Helicobacter growth in vivo and in vitro. Int J Antimicrob Agents. 2009;33(5):473-8.

Sugimoto N, Yoshida N, Nakamura Y, et al. Influence of vitamin E on gastric mucosal injury induced by Helicobacter pylori infection. Biofactors. 2006;28(1):9-19.

Vitor JM, Vale FF. Alternative therapies for Helicobacter pylori: probiotics and phytomedicine. FEMS Immunol Med Microbiol. 2011;63(2):153-64.

Vonkeman HE, Fernandes RW, van de Laar MA. Under-utilization of gastroprotective drugs in patients with NSAID-related ulcers. Int J Clin Pharmacol Ther. 2007;45(5):281-8.

Woodward M, Tunstall-Pedo H, McColl K. Helicobacter pylori infection reduces systemic availability of dietary vitamin C. Eur J Gastroenterol Hepatol. 2001;13(3):233-7.