In short
Most people with gastritis have no symptoms at all. When it does cause trouble, the two things worth identifying are H. pylori infection and regular anti-inflammatory painkillers, because both are fixable.
Emergency if: Vomiting blood or material like coffee grounds, black tarry stools, or severe sudden abdominal pain — go to an emergency department now.
On your report
Hemoglobin, Ferritin, Serum Iron, MCV +2 more
On this page
01
What gastritis is, and is not
Gastritis means inflammation of the stomach lining. Gastropathy is the related term for damage to the lining without much inflammation. Strictly, both are diagnoses made by looking at the lining under a microscope, which is why an endoscopy report and how you feel often disagree.
The majority of people with gastritis or gastropathy do not have any symptoms. That single fact explains a great deal of confusion: a biopsy can report gastritis in someone who feels fine, and someone with daily burning discomfort can have a lining that looks entirely normal. Neither situation is a contradiction.
02
What causes it
Helicobacter pylori infection is the most common cause of gastritis. It is a bacterium that colonises the stomach lining, usually acquired in childhood, and it can persist for decades without symptoms. It matters because it is treatable and because long-standing infection raises the risk of peptic ulcer and, over many years, of stomach cancer.
The other major cause is medicine, principally regular anti-inflammatory painkillers such as ibuprofen, diclofenac and aspirin, which reduce the lining's own protective defences. Alcohol, bile refluxing back into the stomach, severe physical stress from major illness or burns, and autoimmune conditions where the immune system attacks the lining make up most of the rest.
03
Symptoms, when they occur
When gastritis does produce symptoms, they are those of indigestion: discomfort or burning in the upper abdomen, fullness after small meals, nausea, and belching. Symptoms may relate to food in either direction, easing after eating for some and worsening for others, which is why the pattern alone does not identify the cause.
The other way gastritis presents is bleeding from the stomach lining. That can be obvious — vomiting blood or material like coffee grounds, or black tarry stools — or it can be silent, showing up only as iron deficiency anaemia found on a blood test. Unexplained iron deficiency in an adult is a recognised reason to examine the stomach.
04
Testing
Testing for H. pylori is the highest-value step, and a breath test or stool antigen test detects active infection without an endoscopy. Both are affected by recent treatment: acid-suppressing medicines should usually be stopped for about two weeks and antibiotics for four weeks beforehand, or the test can be falsely negative. Blood antibody tests are less useful because they can stay positive long after the infection has gone.
Endoscopy is reserved for people whose symptoms persist despite treatment, who have alarm features, or who are older at first presentation. It allows the lining to be seen and sampled directly, which is the only way to identify the specific type of gastritis and to check for changes in the lining that need follow-up.
05
Treatment
Treatment is chosen according to the type of gastritis and its cause. If H. pylori is found, it is treated with a combination of antibiotics alongside an acid-suppressing medicine, taken for the full course; taking part of the course encourages resistance and leaves the infection in place. Confirming it has gone, with a repeat breath or stool test several weeks after finishing, is an important step that is often skipped.
If anti-inflammatory painkillers are the cause, the useful move is to review whether they are still needed, use the lowest effective dose, or switch to an alternative, with stomach protection when they cannot be stopped. Acid-suppressing medicines relieve symptoms in most other cases, but are intended to be reviewed rather than continued indefinitely without reason.
06
What helps day to day, and what to watch for
Practical measures reduce symptoms even though they do not change the underlying cause: smaller and more regular meals, reducing alcohol, stopping smoking, and identifying your own trigger foods rather than following a generic list, since triggers vary between people. Eating well before lying down helps those whose symptoms overlap with reflux.
Certain features change the plan and should not be managed at home: difficulty swallowing, persistent vomiting, unintentional weight loss, a mass felt in the abdomen, iron deficiency anaemia, or a first onset of significant indigestion in an older adult. Vomiting blood or passing black tarry stools is an emergency.
When to act
Routine — see a doctor
Mild indigestion without alarm features: review painkillers and alcohol, consider testing for H. pylori, and try a short course of acid suppression.
Same-day — call promptly
Difficulty swallowing, persistent vomiting, unintentional weight loss, or newly found iron deficiency anaemia.
Emergency — act now
Vomiting blood or material like coffee grounds, black tarry stools, or severe sudden abdominal pain — go to an emergency department now.
Values mentioned in this story
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Sources
- Gastritis and Gastropathy — NIDDKniddk.nih.gov
- Gastritis — NHSnhs.uk
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