What are the signs and symptoms of gastritis?

Gastritis Signs and Symptoms

Gastritis commonly presents with epigastric pain or discomfort that worsens after eating, along with nausea, early satiety, and bloating, though many patients remain asymptomatic until advanced stages develop. 1

Common Upper Gastrointestinal Symptoms

The typical symptom profile includes:

• Epigastric pain or discomfort that characteristically worsens after meals 1
• Nausea and vomiting which may be persistent or occur in cycles 1
• Early satiety - feeling full after eating only small amounts of food 1
• Bloating and abdominal distension 1
• Heartburn or acid reflux symptoms that can accompany the gastritis 1

Symptoms Related to Nutritional Deficiencies

A critical pitfall is missing the systemic manifestations of gastritis, particularly in chronic or autoimmune forms:

• Iron-deficiency anemia symptoms including fatigue, weakness, and pale skin due to chronic bleeding or malabsorption 1
• Vitamin B12 deficiency manifestations such as neurological symptoms and profound fatigue, particularly characteristic of autoimmune gastritis 2, 1
• Severe weakness and fatigue that may result from anemia or vitamin deficiencies 1

Providers must evaluate for iron and vitamin B12 deficiencies in all patients with atrophic gastritis, especially when corpus-predominant involvement is present 2. Conversely, unexplained iron or B12 deficiency should prompt consideration of atrophic gastritis in the differential diagnosis 2.

Presentation Patterns by Gastritis Type

Chronic Gastritis

• Often asymptomatic in early stages, leading to delayed diagnosis 3
• Gradual development of micronutrient deficiencies over time 3
• May present only with nonspecific dyspeptic symptoms 3

Autoimmune Gastritis

• Frequently asymptomatic until advanced stages 3
• May not present clinically until pernicious anemia develops with fatigue and neurological symptoms 2, 3
• Women are affected more commonly than men 3
• Up to one-third of patients with autoimmune thyroid disease have concurrent autoimmune gastritis 2, 3

H. pylori-Associated Gastritis

• May be completely asymptomatic or present with only mild dyspeptic symptoms 3
• Increases risk of peptic ulcer disease development 3
• The most common form of atrophic gastritis globally 3

Atypical and Concerning Presentations

Be alert for these less typical manifestations:

• Atypical chest pain that can mimic cardiac symptoms 1
• Dyspepsia unresponsive to standard treatments should raise suspicion for gastritis 1
• Nonspecific symptoms like postprandial fullness without clear pain 1

Critical Clinical Pitfall

The major diagnostic challenge is that gastritis is typically asymptomatic and may go undiagnosed, or presents with nonspecific symptoms only late in the disease course 3. This asymptomatic nature, combined with inconsistent histopathological reporting, contributes significantly to underdiagnosis 2, 3. Early diagnosis and treatment are crucial to prevent serious complications including gastric ulcers, bleeding, and increased gastric cancer risk 1.

Associated Autoimmune Conditions

In patients with autoimmune gastritis, providers must screen for concomitant autoimmune disorders, particularly autoimmune thyroid disease, which is common 2. The prevalence of autoimmune gastritis increases with age and the presence of other autoimmune diseases 3.