Gastritis is the histological presence of gastric mucosal inflammation. Helicobacter pylori infection and use of non-steroidal anti-inflammatory drugs (NSAIDs) or alcohol are the most common causes. Other causes include stress (secondary to mucosal ischaemia) and autoimmune gastritis. Rare forms include phlegmonous gastritis (a rare bacterial infection).
Diagnosis is based on clinical history and characteristic histological findings. A variety of methods may be used to diagnose H pylori infection.
Presence of suspicious features suggestive of upper gastrointestinal (GI) malignancy requires urgent endoscopy under appropriate clinical conditions. These include GI bleeding, anaemia, early satiety, unexplained weight loss (>10% body weight), progressive dysphagia, odynophagia, or persistent vomiting.
Treatment depends on the aetiology. Options include H pylori-eradication therapy, reduction of NSAIDs or alcohol exposure, and symptomatic therapy with H₂ antagonists and/or proton-pump inhibitors.
If untreated, progression to peptic ulcer disease may occur. Other complications of some forms of gastritis include gastric carcinoma and gastric lymphoma.
Helicobacter pylori infection may cause both an acute and chronic gastritis. Erosive gastritis may occur in response to non-steroidal anti-inflammatory drugs (NSAIDs), alcohol use or misuse, and to bile reflux into the stomach that may follow previous gastric surgery or cholecystectomy. Stress gastritis, most commonly related to mucosal ischaemia seen in critically ill patients, represents a continuum of disease ranging from superficial (erosions) to deep mucosal damage known as stress ulceration. Autoimmune gastritis is a diffuse form of mucosal atrophy characterised by auto-antibodies to parietal cells and intrinsic factor resulting in inflammatory infiltration and atrophy of the corpus mucosa. Phlegmonous gastritis is a rare but life-threatening infection of the gastric submucosa and muscularis propria seen in immunocompromised patients.
History and exam
Key diagnostic factors
- presence of risk factors
- dyspepsia/epigastric discomfort
- no suspicious features of malignancy
Other diagnostic factors
- nausea, vomiting, and loss of appetite
- severe emesis
- acute abdominal pain
- altered reflexes or sensory deficits
- cognitive impairment
- co-existing autoimmune disease
- Helicobacter pylori infection
- non-steroidal anti-inflammatory drug (NSAID) use
- alcohol use/toxic ingestions
- previous gastric surgery
- critically ill patients
- autoimmune disease
- North European or Scandinavian ancestry
1st investigations to order
- Helicobacter pylori urea breath test
- H pylori faecal antigen test
Investigations to consider
- H pylori rapid urease test
- gastric mucosal histology
- serum vitamin B12
- upper GI contrast series
- blood/fluid cultures
- parietal cell antibodies
- intrinsic factor antibodies
- H pylori culture/polymerase chain reaction (PCR)
at risk of stress gastritis
Helicobacter pylori associated
Eli D. Ehrenpreis, MD, FACG, AGAF
Professor of Medicine
Rosalind Franklin University Medical School
North Chicago, Illinois
Adjunct Professor of Pediatric Gastroenterology
University of Miami Miller Medical School
Associate Director for Research
Internal Medicine Residency
Advocate Lutheran General Hospital
Park Ridge, Illinois
EDE declares that he has no competing interests.
Dr Eli D. Ehrenpreis would like to gratefully acknowledge Dr Nicole Marie Gentile, Dr Parakkal Deepak, and Dr Elad Eichenwald, previous contributors to this topic.
NMG, PD, and EE declare that they have no competing interests.
Anthony Axon, MB, BS, MD, FRCP
Professor and Consultant Gastroenterologist
Department of Gastroenterology
Leeds General Infirmary
AA is the author of studies referenced in this topic.
Garth Swanson, MD
Assistant Professor of Medicine
Section of Gastroenterology and Nutrition
Rush University Medical Center
GS declares that he has no competing interests.
- Peptic ulcer disease (PUD)
- Gastro-oesophageal reflux disease (GORD)
- Non-ulcer dyspepsia
- Informed consent for GI endoscopic procedures
- ACR appropriateness criteria: epigastric pain
Peptic ulcersMore Patient leaflets
- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer