Chronic gastritis

Disease Description (Causes and Symptoms)

• Definition: Chronic gastritis is a condition in which inflammation persists in the gastric mucosa for a prolonged period, causing mucosal changes (superficial inflammation → atrophy, intestinal metaplasia, etc.).
• Major causes: Helicobacter pylori infection, repeated or long-term use of NSAIDs and aspirin, smoking, heavy alcohol consumption, chronic bile reflux, changes after gastric surgery, and autoimmune causes (atrophic gastritis/intrinsic factor deficiency), among others.
• Brief pathophysiology: Persistent inflammation can cause changes in gastric acid secretion (low acid or localized changes in acidity), mucosal atrophy, and intestinal metaplasia. In some cases, there is a risk of progression to bleeding, ulcers, or malignancy (gastric cancer).
• Main symptoms: Upper abdominal pain or discomfort (after meals or on an empty stomach), indigestion, abdominal bloating, nausea and vomiting, decreased appetite, and general fatigue. In severe cases, signs of bleeding such as hematemesis or black stools may occur. Some cases of atrophic gastritis cause few symptoms.

Treatment Methods

• Treatment of the cause
  • Eradication therapy for Helicobacter infection: The prescription varies depending on local antibiotic resistance rates. Common options include a PPI (proton pump inhibitor) + amoxicillin + clarithromycin, or bismuth quadruple therapy including tetracycline or metronidazole. Confirmation of eradication is performed with a urea breath test or stool antigen test at least 4 weeks after treatment.
  • If caused by medications (such as NSAIDs), discontinue or replace the causative medication and administer a PPI if necessary.
• Medications for symptom relief
  • PPIs (e.g., omeprazole and esomeprazole), H2 blockers, gastric mucosal protectants (such as sucralfate), antacids, etc.
• Procedures/Surgery
  • Most cases are managed with nonsurgical treatment. In cases of complications such as bleeding, perforated ulcers, or lesions suspected to be malignant, endoscopic hemostasis or surgery may be necessary.
• Lifestyle management (Important)
  • Stop smoking, avoid heavy alcohol consumption, avoid caffeine, irritating or spicy foods, and excessively hot foods, eat small meals regularly, manage weight, and manage stress.
• Prevention of complications and follow-up
  • If atrophic gastritis or intestinal metaplasia is present, or if there is a family history or other risk factors, undergo regular upper gastrointestinal endoscopy (usually follow-up at intervals of several years, depending on the physician’s judgment) and surveillance with biopsy.
• Special considerations
  • If autoimmune gastritis (antiparietal cell antibodies/intrinsic factor deficiency) is suspected, testing for vitamin B12 deficiency and supplementation should be considered.
  • If eradication treatment fails, the antibiotic combination may be changed, or culture and antibiotic susceptibility testing may be requested.

Checklist Before an Outpatient Visit (Items to Prepare and Sample Questions)

• Items/records to prepare
  • List of currently used medications (including OTC medications: NSAIDs, aspirin, anticoagulants, gastrointestinal medications, etc.) and previous medication history
  • Results of previous upper gastrointestinal endoscopy (including findings and pathology results, if possible)
  • Records of Helicobacter tests (urea breath test, stool antigen test, or biopsy results)
  • Record of when recent symptoms began, their frequency, and triggers (meals, medications, alcohol consumption, etc.)
  • Notes on weight changes, smoking and alcohol consumption, and eating habits
• Examples of information to tell the doctor directly during the outpatient visit
  • Whether there have recently been symptoms suggestive of gastric bleeding (hematemesis or black stools)
  • Whether symptoms of anemia (dizziness or pallor) are present
  • Whether NSAIDs or aspirin have been used long term and the purpose of use (pain, cardiovascular disease, etc.)

General Sample Questions to Ask the Doctor

• “What is the cause of my gastritis, and should I be tested for Helicobacter?”
• “What are the expected side effects of the medication you plan to prescribe? What precautions should I take while taking it?”
• “Given my condition, how high is my risk of gastric cancer, and what follow-up tests should I undergo?”
• “What lifestyle change should I make first to relieve my symptoms?”

Sample Questions Customized to the Disease

• “My endoscopy and biopsy showed atrophic gastritis or intestinal metaplasia. At what intervals should I undergo follow-up endoscopy?”
• “When should I be retested after Helicobacter eradication therapy to confirm eradication, and if eradication fails, what are the next treatment options?”

(Clinical decisions vary depending on the individual patient’s condition and local guidelines. If you have the symptoms described above or suspect bleeding, visit a medical institution immediately.)