Gastritis...That Horrible Feeling in the Pit of Your Stomach
~ by Jo Jordan
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Gastritis may be as common as the cold or flu. In fact, where abdominal pain is present, as many as ten percent of hospital emergency visits are attributable to gastritis.1
But what, exactly, is gastritis? Not a single disease, gastritis refers to several different conditions where inflammation of the gastric mucous membranes of the stomach lining occurs.
Gastritis may be sudden (acute), a reaction to, say, aspirin; long lasting (chronic); or it may coincide with a more serious medical illness.
What Causes Gastritis?
Worldwide, the most common cause of gastritis is infection with Helicobacter pylori bacteria (H. pylori).2 While not everyone develops symptoms or gastritis, by the age of sixty, approximately fifty percent of the population is infected with H. pylori.3
There are numerous other causes and factors related to the onset of gastritis:
- Alcohol consumption
- Aspirin (note that more than 300 medications contain aspirin)
- Autoimmune disorders
- Bacterial infections (i.e. the type that normally cause pneumonia or bladder infection)
- Cancer chemotherapy medications
- Certain allergens
- Certain diseases (i.e. pernicious anemia)
- Certain types of radiation
- Chronic bile reflux
- Chronic vomiting
- Cigarette smoke
- Corrosives (acid or lye)
- Eating disorders (i.e. bulimia)
- Emotional stress
- Excessive caffeine consumption
- Fungal (yeast) infections
- Iron tablets
- Major surgery
- Medical procedures (such as endoscopy)
- Nonsteroidal anti-inflammatory drugs (NSAIDs) (i.e. ibuprofen)
- Parasitic infection / worms (most often from poorly cooked seafood)
- Physical stress (i.e. following a critical illness or injury)
- Potassium supplements
- Severe infections
- Steroid treatments
- Stomach injury
- Stomach surgery
- Swallowing poisons or foreign objects (i.e. paper clips or pins)
- Traumatic injury
- Viral infections
Symptoms of Gastritis
Some people have severe gastritis without experiencing symptoms; conversely, minor stomach lining changes may result in severe symptoms. It’s more common for the elderly to develop stomach damage, and be without symptoms until, quite suddenly, they begin to experience internal bleeding.
Common to all people with gastritis is pain or discomfort, sometimes referred to as dyspepsia, in the pit of the stomach (the left, upper part of the abdomen), through to the back.
Though they can sometimes be related to the underlying cause of gastritis rather than the gastritis itself, other symptoms include:
- A feeling of fullness or burning in the upper abdomen
- Abdominal bloating
- Aching, burning, or gnawing pain
- Appetite loss
- Bloody bowel movements
- Chest pain
- Cutting, sharp, or stabbing pain
- Dark, sticky, extremely foul-smelling bowel movements
- Feeling faint
- Gastric bleeding
- Hyperchlorhydria (an excess of stomach acid)
- Poor pallor
- Rapid or racing heart beat
- Severe stomach pain
- Shortness of breath
- Vomiting blood
Note that black stools or blood in your vomit may be caused by stomach bleeding, which may be symptomatic of a serious health problem requiring immediate medical attention.
As with diagnosing any illness, your health care provider will ask about your symptoms, medical history, and current medications. It is crucial that your physician be aware of habits such as alcohol intake, smoking, and other lifestyle factors that can be associated with gastritis.
Sometimes a detailed interview can provide enough information to make a gastritis diagnosis.
While there are no specific tests to diagnosis gastritis, your health care provider may recommend a variety of tests in order to rule out certain medical conditions. These tests may include:
- An electrocardiogram (ECG) to explore rapid heart beat or chest pains
- Blood cell counts (to test for anemia / low blood count)
- Gallbladder and pancreas functions
- Kidney and liver functions
- Pregnancy test
- Stool tests (to check for blood)
- Tests for H. pylori – urea breath, stool antigen, and/or blood antibody
X-rays or other diagnostic image testing may be required through a gastroenterologist:
- Upper gastrointestinal endoscopy to examine stomach lining, and extract a tissue sample (a biopsy)
- Barium meal X-ray of the esophagus, stomach, and duodenum after the ingestion of liquid barium; the barium-coated stomach lining facilitates a clear X-ray view of the affected area
- Gastroscopy exam of the stomach using a gastroscope inserted via the esophagus
H. Pylori Infection
Gastritis treatment involves removing the irritant or the infection. For example, if you have an H. pylori infection, your health care provider would first prescribe medication to clear up the bacteria.
A combination of antibiotics, acid suppressors (or proton pump inhibitors, also known as PPIs), and stomach protectors taken over a two-week period has ninety percent efficacy rate for resolving H. pylori.4
The antibiotics kill the H. pylori bacteria. Acid-suppressing drugs such as histamine-2 blockers (H2 blockers) reduce the amount of hydrochloric acid released into the digestive tract; proton pump inhibitors suppress acids by shutting down the pumping process in acid-producing cells. A stomach protector or coating agent shields the lining of the stomach and duodenum.
Probiotics supplements have proven to be effective in reducing H. pylori-associated gastritis. Seven of nine human studies showed an improvement of H. pylori gastritis as well as a decrease in H. pylori density after the administration of probiotics.5
Once the underlying H. pylori infection, or any other gastritis-associated problem, has been taken care of, gastritis symptoms normally disappear.
If there isn’t an obvious underlying cause such as H. pylori, it is necessary to identify what your gastritis triggers are. Common avoidable gastritis triggers include the following. Also see the above section What Causes Gastritis?:
- Alcohol consumption
- Aspirin (again, note that more than 300 medications contain aspirin)
- Certain allergens
- Certain foods (often those that are hot and/or highly spiced, such as chili)
- Cigarette smoke
- Coffee and other caffeine-containing beverages such as cola and tea
- Nonsteroidal anti-inflammatory drugs (NSAIDs) (i.e. advil)
Antacids, while often recommended for gastritis relief, ought to be taken with care as they can have various side effects:
- Aluminum-containing antacids – may cause constipation and affect your body’s ability to absorb other medications
- Calcium-containing antacids – also may result in constipation and disrupt absorption capabilities; however, they are especially good at controlling stomach acid and also supplement body calcium
- Magnesium-containing antacids – may cause diarrhea and disrupt absorption capabilities; not recommended for those with kidney problems
Two types of acid-suppressors are currently available:
H2 blockers, some of which are available without a prescription, work by reducing the amount of hydrochloric acid released. Examples are cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), and ranitidine (Zantac).
PPIs suppress stomach acids by shutting down the pumping process in acid-producing cells. Examples include lansoprazole (Prevacid) and omeprazole (Prilosec and Losec).
Stomach protectors or coating agents coat and protect the stomach's lining. Examples include misoprostol (Cytotec) and sucralfate (Carafate).
Antiemetics help control nausea and vomiting. There are numerous examples including metoclopramide (Reglan), ondansetron hydrochloride (Zofran), palonosetron (Aloxi), prochlorperazine (Compazine), and trimethobenzamide (Tigan).
Alternative Treatments and Other Tips
In light of recent findings that ninety percent of gastritis cases are caused by H. pylori, sufferers interested in alternative treatment methods ought to use them in conjunction with traditional medical therapies.
Alternative treatments revolve around diet and nutritional supplements, and tend to be geared toward alleviating gastritis symptoms.
For example, beta-carotene, vitamin A, and zinc are believed to aid in the stomach lining's ability to repair and regenerate itself.6 Herbs thought to stimulate the immune system and reduce inflammation include echinacea and goldenseal.7
Many conditions such as gastritis, Chrohn’s disease, irritable bowel syndrome (IBS), ulcerative colitis, gastric ulcers, and food allergies are believed to be associated with L-glutamine deficiency; gastritis sufferers may benefit from L-glutamine supplementation.
Proper eating habits are vital to alleviating any digestive problems, including gastritis. Try tweaking the way you eat your food:
- Eat only fruit in the morning. Comprised mainly of water, they’re easier to digest than other foods.
- Do not combine major proteins such as chicken, fish, steak, etc. with major/complex carbohydrates...bread, pasta, potatoes, etc. It takes different digestive enzymes to break down carbohydrates than it does proteins. When you combine major carbohydrates and major proteins, you may be putting unnecessary stress onto your digestive system.
- Eat several small meals per day. Eating smaller, more frequent meals (i.e. six small ones per day instead of three large ones) keeps your stomach from getting too full, which in turn reduces gastric pressure.
- Keep a diary of foods and beverages that trigger gastritis symptoms, and then do your best to avoid these products.
For more information on good eating habits, see Puristat’s Dietary Directions online brochure.
A few final points...
Dietary changes are crucial to managing gastritis. It is also important to reduce your stress levels. An unavoidable reality for most of us, stress can be better managed when we eat properly, get enough sleep, and make sure to incorporate some form of exercise into our daily routines.
While in certain cases, gastritis can lead to more serious health problems such as ulcers and an increased risk of stomach cancer, for the most part gastritis – while frustrating and sometimes painful – does tend to improve rapidly with proper dietary self care and medical treatment.
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1. eMedicineHealth, “Gastritis,” http://www.emedicinehealth.com/gastritis/article_em.htm (accessed June 27, 2008).
2. The Merck Manuals Online Medical Library, “Gastritis,” http://www.merck.com/mmhe/sec09/ch121/ch121b.html (accessed June 27, 2008).
4. National Digestive Diseases Information (NDDIC), A service of the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, “H. pylori and Peptic Ulcer,” http://digestive.niddk.nih.gov/ddiseases/pubs/hpylori/index.htm (accessed June 27 2008).
5. PubMed.gov, A service of the U.S. National Library of Medicine and the National Institutes of Health, “Helicobacter pylori and probiotics,” http://www.ncbi.nlm.nih.gov/pubmed/17311980 (accessed June 27, 2008).
6. Health-cares.net, “What’re the treatments for gastritis,” http://digestive-disorders.health-cares.net/gastritis-treatments.php (accessed July 2, 2008).