What are the risk factors for gastritis?

From the Guidelines

Gastritis risk factors primarily include Helicobacter pylori bacterial infection, which is a major cause affecting about half the world's population, as well as regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) and excessive alcohol consumption. According to the study published in the Annual Review of Medicine 1, H. pylori infection is etiologically related to peptic ulcer and gastric cancer, with the lifetime risk of peptic ulcer being approximately 1 in 6 (∼17%) among those infected. The study also highlights that the prevalence of H. pylori infection has steadily declined in more affluent countries due to improvements in sanitation, standards of living, and housing.

Other risk factors for gastritis include:

• Smoking
• Older age, as protective mechanisms decline
• Autoimmune disorders, where the immune system attacks stomach cells
• Bile reflux
• Certain viral or bacterial infections
• Genetic predispositions to gastritis
• Regular use of corticosteroids and certain medical treatments like radiation therapy

The AGA clinical practice update on screening and surveillance in individuals at increased risk for gastric cancer in the United States recommends that high-risk groups, such as first-generation immigrants from high-incidence GC regions and those with a family history of GC, should be considered for screening 1. Endoscopy is the best test for screening or surveillance in individuals at increased risk for GC, and H. pylori eradication is essential for primary and secondary prevention of GC. To reduce the risk of gastritis, it is recommended to limit NSAID and alcohol use, quit smoking, manage stress effectively, and eat smaller, more frequent meals. If symptoms such as persistent stomach pain, nausea, vomiting, or black stools occur, seeking medical attention is advised, as these may indicate gastritis complications.

From the Research

Risk Factors for Gastritis

• Helicobacter pylori infection is a major risk factor for gastritis, with approximately 1 in 5 peptic ulcers associated with H. pylori infection 2
• Nonsteroidal anti-inflammatory drug (NSAID) use is another significant risk factor, with the combination of H. pylori infection and NSAID use synergistically increasing the risk of bleeding ulcers more than sixfold 2
• Other risk factors include:
  • Alcoholism 3
  • Eating quickly and talking during meals 3
  • Stress and anxiety 3
  • Smoking 4
  • Inadequate nutrition 3
  • Associated diseases 3

Role of Proton Pump Inhibitors (PPIs)

• PPIs have antibacterial activity against H. pylori and may exert an anti-inflammatory effect by interfering with the cellular immune response to infection 5
• Chronic use of PPIs may mask H. pylori infections, promoting the diagnosis of non-H. pylori gastritis and leading to a significant drop in H. pylori densities and an increased risk of intestinal metaplasia 4
• PPIs may be used to prevent NSAID-induced ulcers and ulcer complications, but the optimal treatment strategy is still unclear 6

Interaction between H. pylori and NSAID Use

• The presence of H. pylori infection may increase the risk of NSAID-induced ulcers and ulcer complications 2, 6
• Eradicating H. pylori in NSAID users reduces the likelihood of peptic ulcers by one-half 2
• The combination of low-dose misoprostol plus an antisecretory drug (either an H(2)-receptor antagonist or a PPI) may provide superior results compared with either alone for preventing NSAID-induced ulcers and ulcer complications 6