What are the symptoms and treatment options for gastritis?

Symptoms and Treatment of Gastritis

The most common symptoms of gastritis include epigastric pain, nausea, vomiting, abdominal bloating, and early satiety, while treatment should focus on H. pylori eradication (if present), proton pump inhibitors, and lifestyle modifications.

Common Symptoms of Gastritis

Gastritis presents with various symptoms depending on the type, severity, and underlying cause:

Primary Symptoms

• Epigastric pain or discomfort (56% of patients) 1
• Nausea (75% of patients) 1
• Vomiting (50% of patients) 1
• Abdominal bloating (62.5% of patients) 1
• Loss of appetite
• Early satiety
• Indigestion

Less Common Symptoms

• Hematemesis (vomiting blood) in severe cases
• Melena (black, tarry stools) indicating upper GI bleeding
• Weight loss, particularly in chronic cases 2
• Fatigue, which may be related to anemia from vitamin B12 or iron deficiency 3

Types of Gastritis and Specific Symptoms

Atrophic Gastritis

• Often asymptomatic until advanced stages
• May present with symptoms of vitamin B12 and iron deficiencies 3
• Increased risk of gastric cancer in advanced cases 3

H. pylori-Associated Gastritis

• May be asymptomatic or present with epigastric discomfort
• Symptoms improve significantly after H. pylori eradication 1

Autoimmune Gastritis

• Often associated with vitamin B12 deficiency and pernicious anemia 3
• May have concomitant autoimmune disorders, particularly thyroid disease 3

Bile Reflux Gastritis

• Characterized by abdominal pain, bilious vomiting, and weight loss 4
• Often worsened by diet and antacids 4

Diagnostic Approach

Initial Evaluation

• Endoscopy with biopsy is the gold standard for diagnosis
• Testing for H. pylori infection should be performed in all individuals with gastritis 3
• Assess for vitamin B12 and iron deficiencies, especially in corpus-predominant atrophic gastritis 3

Special Considerations

• In autoimmune gastritis, check for antiparietal cell antibodies and anti-intrinsic factor antibodies 3
• Consider screening for autoimmune thyroid disease in patients with autoimmune gastritis 3

Treatment Options

Eradication of H. pylori

• All individuals with H. pylori-positive gastritis should receive eradication therapy 3
• Successful eradication should be confirmed using non-serological testing 3
• Triple therapy (PPI + two antibiotics) leads to significant regression of symptoms and endoscopic features 1

Acid Suppression

• Proton Pump Inhibitors (PPIs) like pantoprazole are first-line medications for symptom relief 5

  • Typical dosing: Pantoprazole 40mg daily for 4-8 weeks
  • Should be taken at the lowest effective dose for the shortest duration needed 5
  • Monitor for potential side effects including kidney problems, C. difficile infection, bone fractures with long-term use 5

• H2 Receptor Antagonists like ranitidine can be used as alternatives 6

  • Symptomatic relief commonly occurs within 24 hours 6

Nutritional Support

• Supplement vitamin B12 and iron if deficient 3
• Dietary modifications:
  • Avoid spicy foods, alcohol, and NSAIDs
  • Avoid mint tea in patients with reflux symptoms 7
  • Small, frequent meals may help reduce symptoms

Management of Specific Types

Bile Reflux Gastritis

• Medical therapy with chelating agents or prokinetics often disappointing 4
• Surgical diversion may be necessary in severe cases 4

Autoimmune Gastritis

• Monitor for development of type 1 gastric neuroendocrine tumors 3
• Consider endoscopic surveillance every 3 years in advanced atrophic gastritis 3

Potential Complications and Monitoring

Complications to Watch For

• Gastric ulcers
• Gastric cancer (especially with advanced atrophic gastritis)
• Vitamin B12 and iron deficiencies leading to anemia
• Gastric neuroendocrine tumors (in autoimmune gastritis)

Long-term Monitoring

• Consider endoscopic surveillance every 3 years for patients with advanced atrophic gastritis 3
• Monitor vitamin B12 and iron levels in patients with corpus-predominant gastritis 3

Treatment Pitfalls to Avoid

1. Failing to test for H. pylori - Always assess for H. pylori infection in all individuals with gastritis 3
2. Prolonged PPI use without indication - Use PPIs at the lowest effective dose for the shortest duration needed 5
3. Overlooking nutritional deficiencies - Screen for vitamin B12 and iron deficiencies, especially in corpus-predominant gastritis 3
4. Missing concomitant autoimmune disorders - Screen for autoimmune thyroid disease in patients with autoimmune gastritis 3
5. Inadequate follow-up - Confirm H. pylori eradication and consider surveillance endoscopy in high-risk patients 3

By addressing both symptoms and underlying causes, most patients with gastritis can achieve significant improvement in their quality of life and reduce the risk of complications.