What are the symptoms and treatment options for gastritis?

Symptoms and Treatment of Gastritis

The most common symptoms of gastritis include epigastric pain or discomfort that may worsen after eating, nausea, vomiting, feeling of fullness after eating small amounts of food, bloating, and heartburn. 1

Common Symptoms

• Epigastric pain or discomfort that typically worsens after meals 1
• Nausea and vomiting, which can be persistent or cyclical 1
• Early satiety (feeling full after eating small amounts) 1
• Bloating and abdominal distension 1
• Heartburn or acid reflux symptoms 1
• Dyspepsia that doesn't respond to standard treatments 1

Severe or Complication-Related Symptoms

• Severe weakness and fatigue, often related to anemia from chronic blood loss 1
• Iron-deficiency anemia symptoms (fatigue, weakness, pale skin) due to chronic bleeding or malabsorption 1, 2
• Vitamin B12 deficiency symptoms (neurological symptoms, fatigue) particularly in autoimmune gastritis 1, 2
• Atypical chest pain that can be confused with cardiac symptoms 1

Symptoms by Type of Gastritis

Chronic Gastritis

• May be asymptomatic in early stages 1, 3
• Gradual development of micronutrient deficiencies (iron and B12) 1, 3
• Can progress to atrophic gastritis with increased risk of gastric cancer 3

Autoimmune Gastritis

• Often asymptomatic until advanced stages 1, 2
• May present with symptoms of pernicious anemia 1, 2
• Associated with other autoimmune disorders, particularly autoimmune thyroid disease 2

H. pylori-Associated Gastritis

• May be asymptomatic or present with mild dyspeptic symptoms 1
• Increases risk of peptic ulcer disease 1, 3

Diagnostic Considerations

• Endoscopy with biopsy is the gold standard for diagnosis 2
• For suspected autoimmune gastritis, check antiparietal cell antibodies and anti-intrinsic factor antibodies 2
• All individuals with atrophic gastritis should be assessed for H. pylori infection 2
• Evaluate for iron and vitamin B12 deficiencies, especially in corpus-predominant atrophic gastritis 2

Treatment Options

Pharmacological Treatment

• Proton pump inhibitors (PPIs) like omeprazole:

  • Reduce acid production in the stomach 4
  • Effective for healing acid-related damage to the esophagus 4
  • Typically used for 4-8 weeks depending on the condition 4

• Histamine H2 receptor antagonists (H2RAs) like ranitidine:

  • Effective for symptom relief in chronic symptomatic gastritis 5
  • Can significantly attenuate epigastralgia, epigastric fullness, and heartburn 5
  • Improve quality of life in patients with chronic symptomatic gastritis 5

Specific Treatment Approaches

• For H. pylori-associated gastritis:

  • Eradication therapy with antibiotics plus PPI 2
  • Confirm successful eradication using non-serological testing 2

• For autoimmune gastritis:

  • Monitor and treat vitamin B12 and iron deficiencies 2, 1
  • Screen for autoimmune thyroid disease 2
  • Consider endoscopic surveillance for gastric neuroendocrine tumors 2

• For severe atrophic gastritis:

  • Consider endoscopic surveillance every 3 years for early gastric cancer detection 2
  • Evaluate for micronutrient deficiencies, particularly iron and vitamin B12 2

Dietary and Lifestyle Modifications

• Avoid triggers that exacerbate symptoms (spicy foods, alcohol, NSAIDs) 6
• Some evidence supports the use of probiotics contained in foods like yogurt and cheese 6
• Food-based therapies such as garlic, turmeric, and honey have been studied but evidence is limited 6

Monitoring and Follow-up

• For patients with atrophic gastritis, consider surveillance endoscopy every 3 years based on individual risk assessment 2
• For autoimmune gastritis with neuroendocrine tumors, surveillance endoscopy every 1-2 years 2
• Monitor for iron and vitamin B12 deficiencies in all patients with atrophic gastritis 2

Complications to Watch For

• Gastric ulcers and bleeding 3, 7
• Increased risk of gastric cancer in severe atrophic gastritis 3
• Malabsorption of essential vitamins and micronutrients (iron, calcium, magnesium, zinc) 3

Remember that early diagnosis and treatment of gastritis are crucial to prevent complications such as gastric ulcers, bleeding, and increased risk of gastric cancer 1, 3.