Characteristics and Management of Gastritis Pain
Gastritis pain typically presents as epigastric discomfort that may occur during meals, accompanied by acid reflux, nausea, and sometimes vomiting, and is best managed through H. pylori testing and eradication if positive, followed by acid suppression therapy with proton pump inhibitors or H2 receptor antagonists. 1, 2
Pain Characteristics
Location and Quality
- Primary location: Epigastric region (upper central abdomen)
- Quality: Often described as burning, gnawing, or cramp-like discomfort
- Timing: May occur during meals (unlike peptic ulcer pain which typically occurs when stomach is empty) 1
- Associated symptoms:
- Acid reflux
- Nausea
- Vomiting
- Bloating
- Loss of appetite
Distinguishing Features
- Unlike peptic ulcer disease, gastritis pain is often less severe and more diffuse
- Pain may worsen with spicy foods, alcohol, or NSAIDs
- Symptoms may be nonspecific and overlap with other conditions 1
- In severe cases, hematemesis (vomiting blood) may occur 1
Clinical Presentation Variations
- Acute gastritis: Sudden onset, more intense pain
- Chronic gastritis: Persistent, often milder discomfort that may be present for months or years
- H. pylori-associated gastritis: May be asymptomatic in many cases despite histological evidence 3
- Autoimmune gastritis: Often associated with vitamin B12 deficiency symptoms 2
Diagnostic Approach
Initial Evaluation
- Endoscopy: Gold standard for diagnosis, showing pale mucosa appearance, loss of gastric rugal folds, and prominence of submucosal blood vessels 2
- Biopsy: Essential for confirming diagnosis and determining etiology
- Topographical biopsies from both body and antrum/incisura in separately labeled jars 2
Testing for H. pylori
- 13C-Urea Breath Test: 95% sensitivity and specificity 2
- Stool Antigen Test: 88-90% sensitivity, 91-100% specificity 2
- Serology (ELISA): 90% sensitivity, 95% specificity 2
Differential Diagnosis
- Peptic ulcer disease
- GERD
- Functional dyspepsia
- Gastric cancer
- Pancreatitis
- Biliary disease
- Myocardial ischemia 1
Management Strategy
First-Line Treatment
H. pylori eradication (if positive):
Acid suppression therapy:
- Proton pump inhibitors (PPIs)
- H2 receptor antagonists 2
Lifestyle modifications:
- Avoid triggers (spicy foods, alcohol, NSAIDs)
- Smaller, more frequent meals
- Smoking cessation
Nutritional Support
- Evaluate for iron and vitamin B12 deficiencies, especially in corpus-predominant or autoimmune gastritis 2
- Provide appropriate supplementation for deficiencies
Follow-up and Surveillance
- Consider surveillance endoscopy every 3 years for advanced atrophic gastritis 2
- For autoimmune gastritis, surveillance interval should be individualized based on risk assessment 2
Special Considerations
Chronic Pain Management
- In cases where pain persists despite resolution of inflammation, consider:
Risk Stratification
- Higher risk of gastric cancer with:
- Advanced atrophic gastritis (OLGA/OLGIM stage III/IV)
- Family history of gastric cancer
- Immigration from high-risk regions
- Persistent H. pylori infection
- Smoking 2
Common Pitfalls to Avoid
- Overlooking H. pylori infection as a cause of gastritis
- Missing nutritional deficiencies, especially in corpus-predominant gastritis
- Failing to consider associated autoimmune conditions in autoimmune gastritis
- Inadequate biopsy sampling during endoscopy 2
- Attributing symptoms solely to histological gastritis, as recent research shows gastritis is often asymptomatic 3
By following this structured approach to diagnosis and management, gastritis pain can be effectively controlled in most patients, improving their quality of life and reducing the risk of complications.