Can Constipation Cause Gastritis?
No, constipation does not cause gastritis—these are separate conditions with distinct pathophysiologies, though they may coexist in the same patient due to shared risk factors or underlying conditions.
Understanding the Relationship
Gastritis is an inflammation of the stomach mucosa primarily caused by Helicobacter pylori infection, autoimmune processes, or other specific etiologies like chronic bile reflux, medications (NSAIDs), or alcohol use 1, 2. Constipation, conversely, results from disordered colonic and/or pelvic floor function, slow colonic transit, or defecatory disorders 1.
Why They May Appear Connected
Shared underlying conditions: Both constipation and gastritis can occur together in patients with systemic diseases like diabetes mellitus (which causes autonomic neuropathy affecting both gastric and colonic motility) 1.
Medication effects: Certain medications can cause both conditions independently—for example, opioids cause constipation 1, while NSAIDs cause gastritis 1.
Autonomic neuropathy: Gastrointestinal neuropathies may involve any portion of the GI tract, manifesting as both gastroparesis (which can present with gastritis-like symptoms) and constipation simultaneously 1.
The Evidence Against Causation
One small observational study suggested that patients with irritable bowel syndrome (which includes constipation-predominant subtypes) had higher rates of chronic gastritis 3. However, this association does not establish causation—both conditions likely share common predisposing factors like H. pylori infection, stress, and dietary habits 4, 3.
Interestingly, successful H. pylori eradication therapy has been shown to improve constipation symptoms in some patients, suggesting that the bacteria—not the constipation itself—may influence both conditions through alterations in gut microbiota 5.
Clinical Approach When Both Are Present
When a patient presents with both constipation and upper GI symptoms suggestive of gastritis:
Rule out H. pylori infection with endoscopy and testing, as this is the dominant cause of chronic gastritis and may also influence constipation through microbiota changes 1, 5.
Assess for systemic causes: Check for diabetes mellitus, hypothyroidism, hypercalcemia, and autoimmune conditions that can affect multiple GI segments 1.
Review medications: Identify constipating drugs (opioids, anticholinergics, calcium channel blockers) and gastritis-inducing agents (NSAIDs) 1, 6.
Treat each condition independently: Use proton pump inhibitors or H2 receptor antagonists for gastritis/reflux 1, and stimulant laxatives (bisacodyl 10-15 mg 2-3 times daily) or osmotic agents (polyethylene glycol 17g daily) for constipation 1, 7, 8.
Key Pitfall to Avoid
Do not assume that treating constipation will resolve gastritis symptoms or vice versa. Each requires specific, targeted therapy based on its underlying etiology 1. The coexistence of these conditions should prompt investigation for shared systemic causes rather than assuming a direct causal relationship 1.