Signs and Symptoms of Gastritis
The primary signs and symptoms of gastritis include epigastric pain, nausea, vomiting, bloating, indigestion, and loss of appetite, though many patients may be asymptomatic despite histological evidence of inflammation. 1
Clinical Presentation
Common Symptoms
- Epigastric pain/discomfort: Often described as burning or gnawing pain in the upper central abdomen
- Nausea and vomiting
- Early satiety (feeling full quickly)
- Bloating
- Indigestion/dyspepsia
- Loss of appetite
- Belching
Less Common Symptoms
- Hematemesis (vomiting blood): May indicate erosive gastritis or ulceration
- Melena (black, tarry stools): Suggests gastrointestinal bleeding
- Weight loss: More concerning when unintentional and significant
Physical Examination Findings
- Epigastric tenderness on abdominal palpation
- Normal vital signs in most cases of uncomplicated gastritis
- Pallor may be present if anemia has developed due to chronic blood loss or vitamin B12 deficiency (particularly in autoimmune gastritis)
Laboratory and Diagnostic Findings
Laboratory Abnormalities
- Anemia: May be present in cases of chronic gastritis with bleeding or autoimmune gastritis (pernicious anemia)
- Iron deficiency: Common in H. pylori-associated or autoimmune gastritis 1
- Vitamin B12 deficiency: Particularly in autoimmune gastritis 1
- Positive H. pylori tests: Urea breath test, stool antigen test, or serology (ELISA) 2
- Antiparietal cell antibodies and anti-intrinsic factor antibodies: Present in autoimmune gastritis 1
Endoscopic Findings
- Mucosal erythema (redness)
- Edema
- Pale appearance of gastric mucosa in atrophic gastritis 1
- Increased visibility of submucosal blood vessels due to mucosal thinning 1
- Loss of gastric rugal folds in advanced cases 1
- Erosions or ulcerations in more severe cases
- Nodularity may be present with intestinal metaplasia 1
Types of Gastritis and Specific Presentations
H. pylori-Associated Gastritis
- Often asymptomatic
- May present with dyspepsia, epigastric pain
- Can lead to peptic ulcer disease with more severe symptoms 2
Autoimmune Gastritis
- Often asymptomatic until advanced stages
- May present with symptoms of vitamin B12 deficiency (fatigue, weakness, neurological symptoms)
- Associated with other autoimmune conditions like type 1 diabetes and Addison's disease 1
Erosive/Hemorrhagic Gastritis
- More likely to present with hematemesis or melena
- May be associated with NSAID use, alcohol consumption, or severe stress
Important Clinical Considerations
Asymptomatic Nature
Recent evidence indicates that gastritis is often asymptomatic despite histological inflammation. A 2024 study found that gastritis was present in 40.2% of a community population, but there was no significant difference in upper gastrointestinal symptoms between those with and without gastritis 3.
Alarm Symptoms
Certain symptoms warrant immediate evaluation:
- Hematemesis
- Melena
- Unintentional weight loss
- Progressive dysphagia
- Persistent vomiting
- Anemia
- Age >45 years with new-onset symptoms 1
Complications
Chronic gastritis, especially when untreated, can lead to:
- Peptic ulcer disease: With risk of bleeding, perforation, and obstruction
- Atrophic gastritis: Leading to malabsorption of nutrients
- Gastric cancer: Particularly with long-standing H. pylori infection and intestinal metaplasia 4
- Pernicious anemia: In autoimmune gastritis 1
Clinical Pitfalls to Avoid
- Assuming all gastritis is symptomatic: Many cases are asymptomatic despite histological changes 3
- Overlooking H. pylori infection: A major cause of chronic gastritis worldwide 2, 5
- Missing nutritional deficiencies: Particularly iron and vitamin B12 1, 2
- Failing to consider autoimmune gastritis: Especially in patients with unexplained iron deficiency anemia or vitamin B12 deficiency 1
- Not recognizing alarm symptoms: Which may indicate complications or more serious conditions
Understanding the diverse presentation of gastritis is essential for proper diagnosis and management, especially considering that histological gastritis may not always correlate with clinical symptoms.