Gastritis

Disease Description (Causes and Symptoms)

• Definition: A condition in which inflammatory cells infiltrate the gastric mucosa (acute or chronic gastritis). Based on endoscopic findings, it is classified as erythematous, erosive, hemorrhagic, bile reflux, chronic superficial, atrophic, metaplastic, hypertrophic, and other types.
• Main causes
  • Helicobacter pylori (H. pylori) infection — one of the main causes of chronic gastritis
  • Mucosal injury caused by medications (such as aspirin and NSAIDs) (inhibition of prostaglandin synthesis)
  • Alcohol, exposure to strong acids or alkalis, certain infections (bacterial, parasitic, or fungal), and severe stress (trauma, burns, or critical illness)
  • Bile reflux (chemical gastritis)
• Pathophysiology summary: When the mucosal defense mechanisms (mucus layer, cell regeneration, blood flow, etc.) are disrupted, inflammation and mucosal injury occur. H. pylori invades the mucosa and induces inflammation, while NSAIDs promote mucosal injury by reducing protective prostaglandins. Chronic inflammation can cause atrophy, metaplasia, and intestinal metaplasia, which may increase the risk of gastric cancer.
• Main symptoms: Upper abdominal pain or burning, epigastric pain, indigestion (early satiety and bloating), nausea and vomiting, heartburn, or no symptoms. Severe bleeding may cause hematemesis, melena, or symptoms of anemia.

Treatment

• General principles: Correct or eliminate the cause where possible → relieve symptoms and prevent complications
• Medication
  • Acid-suppressing medications: Proton pump inhibitors (PPIs; e.g., omeprazole) are used first and are effective for relieving symptoms and reducing the risk of bleeding
  • H2 blockers and antacids: May be used for short-term symptom relief
  • Mucosal protectants (such as sucralfate): Adjunctive treatment for erosive or hemorrhagic lesions
  • Antiemetics (for nausea and vomiting) and prokinetic agents (if needed)
• H. pylori-related treatment
  • Eradication therapy is recommended when infection is confirmed. Representative options include standard triple therapy (PPI + clarithromycin + amoxicillin) or bismuth quadruple therapy (PPI + bismuth + tetracycline + metronidazole). Select an appropriate regimen according to local antibiotic resistance rates.
  • Confirming eradication: Confirm with a urea breath test or stool antigen test at least 4 weeks after completion of treatment (taking antibiotics or PPIs can affect test sensitivity).
• Acute bleeding/severe erosive gastritis: Fasting, intravenous fluids, high-dose PPI administration, and endoscopic hemostasis if necessary
• Medication-induced gastritis (e.g., NSAIDs): Discontinue or replace the causative medication; protect the mucosa with concomitant PPI treatment
• Lifestyle management and precautions
  • Stop smoking, limit alcohol, restrict caffeine and irritating foods (such as spicy and fatty foods), and eat small, regular meals slowly
  • Consult a doctor when using NSAIDs; use a PPI together for protection if necessary
  • Consult a medical professional immediately if severe pain, persistent vomiting, weight loss, or evidence of bleeding (hematemesis or melena) occurs
• Risk of complications: Gastric ulcers, gastric bleeding, and perforation; increased risk of gastric cancer due to chronic atrophy or metaplasia; malabsorption (in severe cases)

Checklist Before an Outpatient Visit (Including Preparation and Sample Questions)

• Items/information to prepare
  • List of current medications (including prescription drugs, OTC medications, herbal medicines, and supplements) and duration of use
  • Previous gastrointestinal test results (endoscopic findings, biopsy results, H. pylori test results, etc.) or copies of medical records
  • Timing and pattern of symptoms (when they began, relationship to eating after meals or on an empty stomach, and factors that worsen or improve them)
  • Associated symptoms (vomiting, vomiting blood, black stools, weight loss, difficulty swallowing, etc.) and record of their severity
  • Lifestyle information (smoking, alcohol use, NSAID or aspirin use, and stress level)
• Examples of what to tell the doctor in advance during the outpatient visit
  • “I have had upper abdominal pain and early satiety that have persisted for the past X weeks.”
  • “I am currently taking aspirin (or an NSAID) every day.”
  • “I was told that I had atrophic gastritis and metaplasia on a previous endoscopy (include the examination date if available).”

Examples of General Questions to Ask the Doctor

• What are the expected side effects and precautions for this medication (or eradication therapy)?
• If I test positive for H. pylori, which eradication therapy do you recommend? Is resistance testing (culture/molecular testing) necessary?
• If my symptoms do not improve, when should I have repeat testing (endoscopy)?
• I need to take an NSAID (or aspirin). What should I do to protect my stomach?
• If I have atrophic gastritis or metaplasia, how often should I have follow-up endoscopy?

Examples of Disease-Specific Questions

• H. pylori-related: “My test was positive for H. pylori. Considering the local clarithromycin resistance rate, which eradication therapy is most appropriate?”
• Atrophic/metaplastic gastritis-related: “Atrophic gastritis (or intestinal metaplasia) was observed on my endoscopy. What should I know about gastric cancer prevention, the interval for follow-up testing, and any lifestyle changes I should make in particular?”

Note: The information above is general medical information. Please consult your doctor to determine an accurate diagnosis and treatment plan appropriate for your individual condition.