Symptoms and Treatment of Gastritis
Gastritis presents with epigastric pain, nausea, vomiting, bloating, and in advanced cases may cause fatigue due to vitamin B12 or iron deficiency; treatment requires H. pylori eradication if positive, proton pump inhibitors for symptom relief, and lifestyle modifications including avoidance of spicy foods, alcohol, and NSAIDs. 1
Common Symptoms of Gastritis
Gastritis can present with various symptoms, though some patients may be asymptomatic:
- Epigastric or abdominal pain
- Nausea and vomiting
- Bloating and abdominal discomfort
- Dyspepsia (indigestion)
- Anorexia (loss of appetite)
- Weight loss in severe cases
- Fatigue related to anemia from vitamin B12 or iron deficiency 1
- Regurgitation and heartburn symptoms 2
In advanced cases, symptoms related to vitamin deficiencies may become prominent, particularly B12 and iron deficiencies, which can lead to anemia and associated symptoms 1.
Diagnosis of Gastritis
Proper diagnosis is essential for effective management:
- Endoscopy with biopsy is the gold standard for diagnosis 1
- Testing for H. pylori infection should be performed in all individuals with gastritis 1
- Assessment for vitamin B12 and iron deficiencies, especially in corpus-predominant atrophic gastritis 1
Treatment Approach for Gastritis
1. H. pylori Eradication
- All individuals with H. pylori-positive gastritis should receive eradication therapy 1
- Successful eradication should be confirmed using non-serological testing 1
- H. pylori eradication significantly improves symptoms and prevents progression to complications 3
2. Acid Suppression Therapy
- Pantoprazole and other proton pump inhibitors (PPIs) can help reduce symptoms by decreasing stomach acid production 4
- PPIs should be used at the lowest effective dose and for the shortest duration needed 4
- Important exception: In autoimmune gastritis, acid suppressant medications are ineffective and should be discontinued as these patients already have achlorhydria (inability to produce stomach acid) 2
3. Nutritional Support
- Supplement vitamin B12 and iron if deficient 1
- Monitor vitamin B12 and iron levels in patients with corpus-predominant gastritis to prevent deficiencies 1
4. Lifestyle Modifications
- Avoid spicy foods, alcohol, and NSAIDs to reduce symptoms 1
- Avoid mint tea in patients with reflux symptoms 1
- Consume small, frequent meals to help reduce symptoms 1
Special Considerations for Different Types of Gastritis
Autoimmune Gastritis
- Characterized by atrophy of acid-secreting parietal cells and achlorhydria
- PPIs are ineffective and should be discontinued
- Consider gastric acidification therapy in some cases 2
Bile Reflux Gastritis
- Often presents with bilious vomiting, abdominal pain, and weight loss
- Medical therapy with chelating agents or motility drugs has limited effectiveness
- Surgical diversion (Roux-en-Y) may be necessary in severe cases 5
Nodular Gastritis
- Presents with epigastric pain, nausea, vomiting, and abdominal bloating
- Strongly associated with H. pylori infection
- Triple therapy against H. pylori leads to significant regression of symptoms and endoscopic features 3
Monitoring and Follow-up
- Consider endoscopic surveillance every 3 years in advanced atrophic gastritis to monitor for complications 1
- Monitor for development of type 1 gastric neuroendocrine tumors 1
- Regular assessment of vitamin B12 and iron levels in patients with corpus-predominant gastritis 1
Important Cautions with PPI Therapy
Pantoprazole and other PPIs can cause serious side effects including:
- Acute interstitial nephritis
- Clostridium difficile infection
- Bone fractures with long-term use
- Certain types of lupus erythematosus
- Low vitamin B12 levels with long-term use 4
Common Pitfalls in Gastritis Management
- Failure to test for H. pylori infection in all patients with gastritis 1
- Not screening for vitamin B12 and iron deficiencies, especially in corpus-predominant gastritis 1
- Using acid suppressants in autoimmune gastritis where they are ineffective 2
- Not confirming H. pylori eradication after treatment 1
- Failure to recognize increased risk of gastric cancer in advanced cases of gastritis 1