Is gastritis a permanent condition or can it be cured?

Management of Gastritis: Resolution and Recurrence

Gastritis can be cured with appropriate treatment, particularly when the underlying cause is identified and addressed, but may recur if risk factors persist or if it's related to autoimmune processes.

Types of Gastritis and Their Outcomes

H. pylori-Associated Gastritis

• H. pylori-associated gastritis (HpAG) is the most common form of atrophic gastritis and can be effectively treated with eradication therapy 1
• All individuals with atrophic gastritis should be assessed for H. pylori infection, and if positive, treatment should be administered with confirmation of successful eradication 1
• After successful H. pylori eradication, the gastritis typically resolves and does not recur unless reinfection occurs 1
• The antibiotic combination for H. pylori treatment should be chosen according to local antibiotic resistance patterns 1

Autoimmune Gastritis

• Autoimmune gastritis (AIG) is a chronic condition that generally does not resolve completely once established 1, 2
• AIG is characterized by corpus-predominant atrophy with antibodies against parietal cells and intrinsic factor 1, 3
• Women have a higher prevalence of AIG compared to men, and it's associated with other autoimmune disorders 1, 2
• Patients with autoimmune gastritis should be screened for autoimmune thyroid disease, which commonly co-occurs 1

Risk of Progression and Complications

Progression to Cancer

• Atrophic gastritis is considered the first step in a precancerous cascade that can lead to gastric adenocarcinoma 1
• The risk of progression from atrophic gastritis to gastric adenocarcinoma ranges from 0.1% to 0.3% per year 1
• H. pylori eradication should be considered for gastric cancer prevention in high-risk individuals 1
• Patients with severe atrophic gastritis require endoscopic surveillance due to increased cancer risk 1

Neuroendocrine Tumors

• Patients with chronic atrophic gastritis, particularly autoimmune gastritis, are at increased risk of type I gastric neuroendocrine tumors (0.4-0.7% per year) 1
• Individuals with autoimmune gastritis should be screened for type 1 gastric neuroendocrine tumors with upper endoscopy 1

Monitoring and Follow-up

Endoscopic Surveillance

• The optimal endoscopic surveillance interval for patients with atrophic gastritis should be based on individual risk assessment 1
• A surveillance endoscopy every 3 years should be considered in individuals with advanced atrophic gastritis 1
• Small neuroendocrine tumors should be removed endoscopically, followed by surveillance endoscopy every 1-2 years 1

Nutritional Deficiencies

• Providers should evaluate for iron and vitamin B-12 deficiencies in patients with atrophic gastritis, especially if corpus-predominant 1
• Pernicious anemia is a late-stage manifestation of autoimmune gastritis characterized by vitamin B-12 deficiency and macrocytic anemia 1

Clinical Pearls and Pitfalls

• Gastritis is often asymptomatic and may go undiagnosed until complications develop 1, 2
• The estimated prevalence of atrophic gastritis is up to 15% in US populations, with potentially higher rates in specific high-risk groups 1, 2
• Inconsistent reporting of atrophic gastritis on histopathology contributes to underdiagnosis 1
• Patients with unexplained iron or vitamin B-12 deficiency should be evaluated for atrophic gastritis 1
• Risk factors for non-autoimmune atrophic gastritis include age, tobacco use, high-salt diet, and possibly chronic bile acid reflux 1, 4

Treatment Approaches

• For H. pylori-associated gastritis, eradication therapy is curative and prevents recurrence 1
• For autoimmune gastritis, treatment focuses on managing nutritional deficiencies and surveillance for complications 1
• Symptomatic management may be sufficient for some forms of gastritis without specific interventions 5, 6
• Awareness of the gastritis-cancer connection and implementation of appropriate surveillance programs can significantly reduce the risk of gastric neoplasms 7