Overview#
Gastritis is the inflammation of the stomach lining (mucosa), which can be acute (sudden onset) or chronic (developing gradually over months to years). It is extremely common in India, driven by high H. pylori infection rates (estimated 60-70 % of the population is infected), widespread use of NSAIDs, spicy food habits, and stress. While mild gastritis is self-limiting, chronic gastritis – particularly due to H. pylori – can lead to peptic ulcers, gastric atrophy, and in rare cases, stomach cancer.
Causes & Risk Factors#
- Helicobacter pylori (H. pylori) infection – the most common cause of chronic gastritis worldwide; endemic in India with 60-70 % prevalence.
- NSAID overuse – ibuprofen, diclofenac, aspirin, and other painkillers damage the protective mucus layer. Self-medication with OTC painkillers is a huge problem in India.
- Excessive alcohol consumption – directly irritates and erodes the gastric lining.
- Spicy and acidic foods – while they do not cause gastritis, they can aggravate an already inflamed stomach.
- Chronic stress – increases acid production and reduces mucosal blood flow.
Signs & Symptoms#
- Burning or gnawing pain in the upper abdomen (epigastric region)
- Bloating and feeling of fullness after small meals
- Nausea and sometimes vomiting
- Loss of appetite
- Belching and acid reflux (heartburn)
- Indigestion (dyspepsia) worsened by spicy, oily, or acidic foods
- In severe cases: vomiting blood (haematemesis) or black tarry stools (melena) indicating bleeding
Diagnosis#
- Upper GI Endoscopy – the definitive test; allows direct visualisation of the stomach lining and biopsy for H. pylori and cancer screening.
- H. pylori testing:
- Urea Breath Test (UBT) – non-invasive; the best test for active infection. Book H. pylori Test
- Stool Antigen Test – also non-invasive and reliable.
- Biopsy-based rapid urease test (CLO test) – done during endoscopy.
- H. pylori IgG antibody – indicates past exposure but cannot differentiate active from past infection.
- Complete Blood Count – to check for anemia from chronic bleeding. Book CBC
Treatment Options#
H. pylori eradication therapy (if positive):
- Standard triple therapy: PPI (pantoprazole/omeprazole) + amoxicillin + clarithromycin for 14 days.
- Bismuth quadruple therapy for resistant cases: PPI + bismuth subsalicylate + metronidazole + tetracycline.
- Confirm eradication with urea breath test or stool antigen 4 weeks after completing antibiotics.
Acid suppression:
- Proton Pump Inhibitors (PPIs): Pantoprazole, omeprazole, rabeprazole – taken 30 minutes before breakfast. Most effective for healing gastritis.
- H2 Blockers: Ranitidine (withdrawn in many countries), famotidine – for milder cases.
- Antacids: Aluminium hydroxide, magnesium hydroxide (Gelusil, Digene) – provide quick symptomatic relief.
Dietary modifications:
- Eat smaller, more frequent meals – avoid large heavy meals.
- Reduce spicy food, citrus, tomato-based dishes, and caffeine.
- Avoid eating late at night – allow 2-3 hours between dinner and sleep.
- Include cooling foods: cold buttermilk (chaas), banana, coconut water, and fennel (saunf) tea.
Prevention#
- Test for and treat H. pylori infection, especially if you have recurrent symptoms.
- Avoid long-term NSAID use – if needed, take them with food and a PPI cover.
- Eat at regular intervals – do not skip meals, as empty stomach increases acid contact with mucosa.
- Manage stress through yoga, meditation, or regular exercise.
- Limit alcohol consumption and quit smoking – both impair mucosal healing.
When to See a Doctor#
Consult a gastroenterologist if you have persistent upper abdominal pain for more than 2 weeks, unexplained weight loss, difficulty swallowing, or symptoms unresponsive to antacids. Seek emergency care for vomiting blood (even small amounts), black tarry stools, or severe abdominal pain with dizziness – these indicate gastrointestinal bleeding requiring urgent intervention.