Key Differences Between GERD and Gastritis
The primary difference between GERD and gastritis is their anatomical location and underlying pathophysiology: GERD affects the esophagus due to reflux of gastric contents, while gastritis involves inflammation of the stomach lining itself.
Anatomical Location and Definition
GERD
- Location: Affects the esophagus
- Definition: A condition where gastric contents flow back (reflux) into the esophagus causing troublesome symptoms and/or complications 1
- Mechanism: Primarily involves transient relaxations of the lower esophageal sphincter (LES) allowing stomach contents to enter the esophagus 1
Gastritis
- Location: Affects the stomach lining
- Definition: Inflammation of the gastric mucosa (stomach lining)
- Mechanism: Often caused by Helicobacter pylori infection, NSAIDs, alcohol, or autoimmune processes 2
Symptoms
GERD
- Typical symptoms:
- Heartburn (retrosternal burning sensation)
- Regurgitation (backflow of gastric contents into mouth)
- Dysphagia (difficulty swallowing)
- Chest pain 1
- Atypical symptoms:
- Chronic cough
- Hoarseness
- Throat clearing
- Asthma exacerbations 1
- Silent presentation: Can be "silent" from a GI standpoint up to 75% of the time 1
Gastritis
- Common symptoms:
- Epigastric pain or discomfort
- Nausea
- Vomiting
- Early satiety
- Upper abdominal bloating
- Distinctive feature: Pain typically centered in the upper middle region of the abdomen
- Bleeding: May present with hematemesis or melena in severe cases
Diagnostic Approaches
GERD
- Endoscopic findings:
- Erosive esophagitis
- Barrett's esophagus
- Strictures
- Rings and furrows 1
- pH monitoring: Detects abnormal acid exposure in the esophagus
- Impedance testing: Identifies both acid and non-acid reflux events
- Clinical diagnosis: Often made based on typical symptoms responding to PPI therapy 1
Gastritis
- Endoscopic findings:
- Erythema
- Erosions
- Nodularity of gastric mucosa
- Biopsy: Required for definitive diagnosis and classification (acute vs. chronic, H. pylori status)
- Pattern: Can be antral predominant or corpus predominant 2
- H. pylori testing: Crucial for determining etiology and treatment approach
Relationship with H. pylori
GERD
- Complex relationship: H. pylori infection may actually protect against GERD in some cases 3, 4
- Post-eradication: Some studies suggest increased GERD symptoms after H. pylori eradication 3
- Mechanism: H. pylori-induced gastritis can reduce acid production, potentially decreasing reflux 4
Gastritis
- Strong association: H. pylori is the primary cause of chronic gastritis worldwide
- Pattern: Often causes antral predominant gastritis, which has been associated with increased GERD 2
- Progression: Can lead to atrophic gastritis and intestinal metaplasia if untreated
Treatment Approaches
GERD
- First-line: Lifestyle modifications (weight loss, head elevation, avoiding trigger foods)
- Medications:
- Proton pump inhibitors (PPIs)
- H2-receptor antagonists
- Antacids
- Prokinetics in selected cases 1
- Surgical options: Fundoplication for refractory cases
Gastritis
- H. pylori eradication: Triple or quadruple therapy if H. pylori positive
- Acid suppression: PPIs or H2-blockers to reduce symptoms
- Avoidance of triggers: NSAIDs, alcohol, spicy foods
- Cytoprotective agents: Sucralfate or misoprostol in selected cases
Complications
GERD
- Esophageal complications:
- Erosive esophagitis
- Barrett's esophagus (precancerous condition)
- Esophageal strictures
- Esophageal adenocarcinoma 1
- Extraesophageal complications:
- Chronic cough
- Laryngitis
- Asthma exacerbations
- Dental erosions 1
Gastritis
- Acute complications:
- Gastric bleeding
- Erosions
- Chronic complications:
- Atrophic gastritis
- Intestinal metaplasia
- Gastric ulcers
- Increased risk of gastric cancer (especially with H. pylori)
Clinical Pearls and Pitfalls
- Coexistence: GERD and gastritis can coexist in the same patient, complicating diagnosis and treatment
- Symptom overlap: Epigastric pain can occur in both conditions, making clinical differentiation challenging
- Response to PPIs: Both conditions may respond to PPIs, but for different reasons
- Diagnostic pitfall: Assuming all upper abdominal discomfort is GERD without considering gastritis
- Treatment pitfall: Eradicating H. pylori without considering its potential protective effect against GERD in some patients 3
- Age consideration: In patients under 50 years, endoscopy-negative GERD is more common (85%), while older patients are more likely to have visible lesions 5
Understanding these key differences helps guide appropriate diagnostic workup and treatment selection for patients presenting with upper gastrointestinal symptoms.