Medically Reviewed by a Doctor on 8/28/2015

Medical Author: Jerry R. Balentine, DO, FACEP

Medical Editor: Bhupinder Anand, MD

Classification of gastritis
Erosive Gastritis

Acute gastritis includes hemorrhagic or erosive gastritis, H pylori gastritis, and acute
phlegmonous gastritis. Although erosive gastritis may result from various causes and may show
acute or chronic changes pathologically, the radiologic hallmark is multiple erosions (Fig 1). The
most common causes of erosions include ingestion of aspirin or other nonsteroidal anti-
inflammatory drugs (NSAIDs), alcohol, stress, trauma, burns, viral or fungal infection, and
Crohn's disease; however, up to half of patients with this disorder do not have apparent
predisposing factors.[5] Helicobacter pylori may cause an acute or chronic gastritis and is
associated with peptic ulcers, but the relationship to erosions is uncertain.

The reported radiologic prevalence of erosive gastritis is 1.7% to 26%. [6,7] In most patients, images show
complete or varioliform erosions, which appear as punctate or linear barium collections surrounded by
radiolucent halos of edematous mucosa. Double-contrast or compression radiologic views best reveal
gastric erosions. These nodular erosions typically occur in the gastric antrum, often aligned on antral
folds. Gastritis caused by aspirin and NSAIDs may appear as linear or serpiginous erosions in the body or
near the greater curvature, because these are dependent portions of the stomach where the medication
settles while dissolving.[5,8] Erosions may be subtle; the primary finding may be thickening of the antral
folds. If the shallow epithelial defects have healed, the only evidence is nodularity, which can mimic
antral polyps from various causes. Most inflammatory nodules caused by gastritis are small and do not
project clearly into the lumen. These nodules are usually less than 1 cm in diameter. The characteristic
appearance of gastritis is that of inflammatory nodules lined up on the folds of the gastric antrum.

Helicobacter pylori Gastritis

Helicobacter pylori was first isolated in 1983 and is now recognized as a major factor in the
development of peptic ulcer disease, chronic gastritis, and, potentially, gastric malignancy.[9]
Infection with H pylori is ubiquitous. The prevalence of H pylori ranges from 60% to 80% in
patients with gastric ulcer and 90% to 100% in those with duodenal ulcer.[10] A common cause of
gastric infection, H pylori is age-related; it is found in 24% of the population 20 to 39 years of
age and in 82% of the population 60 years of age and older.[11]

Most patients with peptic ulcers are infected with this organism. In one study, thickened folds
were detected in 44% of patients with H pylori[12] (Fig 2). The antrum was a common site
affected, but the entire stomach may be involved.[13] In addition to thickened antral mucosal
folds, other possible signs include irregular contour of the lesser curvature, erosions, polypoid
folds, ulcers (14%), nodularity, enlarged areae gastricae (16%), narrowing (9%), polyps (6%),
and spasm.[10,12] In a small percentage of patients without H pylori infection, findings may be
similar. The role of radiographic imaging in evaluating H pylori gastritis warrants further study.

REFERENCE: Wehbi, M. MD. Acute Gastritis. Medscape. Sep 18, 2014

http://www.emedicinehealth.com/gastritis/topic-guide.htm
Medically Reviewed by a Doctor on 8/28/2015
Medical Author: Jerry R. Balentine, DO, FACEP
Medical Editor: Bhupinder Anand, MD

Hyperplastic Gastropathy

Hyperplastic gastropathy is a pathologic term that includes hypertrophic gastritis, Ménétrier's

disease, and Zollinger-Ellison syndrome. Several of these entities may mimic other forms of
gastritis on radiologic examination and are included as differential considerations. The term
"hypertrophic gastritis" is a misnomer, because rugal fold thickening due to hyperplasia and
inflammation may be absent in these disorders. Thick folds can be defined as gastric folds more
than 5 mm in caliber as measured on radiographs obtained with the stomach moderately
distended.[12]

The radiologic findings in these gastropathies are often similar. Marked thickening of gastric
folds with a bizarre appearance is seen in the gastric fundus and along the greater curvature (Fig
5). Antral sparing may be a feature of Ménétrier's disease (Fig 6), but the validity of this finding
has been debated. In Zollinger-Ellison syndrome, peptic ulcers, hypersecretion, and enteric fold
thickening may be additional radiographic features. Most importantly, hyperrugosity as a result
of other causes, such as gastric lymphoma (Fig 7), carcinoma (Fig 8), and H pylori infection
must also be considered in the differential possibilities.[12]

Miscellaneous Types

A heterogeneous assortment of other causes of gastritis includes infectious and noninfectious

forms. Organisms other than H pylori, such as mycobacteria (tuberculosis, Mycobacterium
avium intracellulare), Treponema pallidum, viruses (cytomegalovirus),[15] fungi (candida), and
parasites (Cryptosporidium, Giardia lamblia, Anisakiasis), can cause gastritis. Tuberculosis and
syphilis were common in the early part of the last century; different organisms are implicated
more recently, particularly in patients with the acquired immunodeficiency syndrome.
Noninfectious causes are numerous and encompass granulomatous diseases (such as Crohn's
disease), sarcoidosis, eosinophilic gastroenteritis, and radiation, chemical causes (bile reflux or
corrosives), or injury.[1,16,17]

The radiologic findings in these varied gastritides may be specific (eg, phlegmonous gastritis) or
may include a broad differential list requiring careful clinical correlation. Antral narrowing is a
common finding in a number of these disorders, such as Crohn's disease and syphilis, but other
diseases causing similar appearances, such as scirrhous carcinoma, must be excluded.

Sumber : http://www.medscape.com/viewarticle/410726_2

REFERENCE: Wehbi, M. MD. Acute Gastritis. Medscape. Sep 18, 2014

http://www.emedicinehealth.com/gastritis/topic-guide.htm
Medically Reviewed by a Doctor on 8/28/2015
Medical Author: Jerry R. Balentine, DO, FACEP
Medical Editor: Bhupinder Anand, MD

Gastritis Quick Overview

 Gastritis is an inflammation or irritation of the lining of the stomach.

 Gastritis has many causes, including as a result of an infection with the same bacteria that
causes most stomach ulcers.
 Gastritis can be a brief and sudden illness (acute gastritis), a longer-lasting condition
(chronic gastritis), or a special condition, perhaps as part of another medical illness
(atrophic gastritis, autoimmune gastritis, eosinophilic gastritis).
 An example of acute gastritis is stomach upset that may follow the use of alcohol or
certain medications such as aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs).
 An example of chronic gastritis is Helicobacter pylori or H. pylori, a type of bacteria that
infects the stomach.
 Foods that may cause gastritis can differ from person to person, but in general, foods that
can cause gastritis include
 beverages that contain alcohol or caffeine,
o spicy foods,
o foods that contain chocolate, or
o foods high in fat.
 Symptoms of gastritis are
o indigestion (burning pain in upper abdomen or "pit" of the stomach),
o nausea or vomiting,
o pain in the upper abdomen.
 Home remedies for gastritis include changing the diet and avoiding alcohol. If the person
is taking pain relievers that can cause gastritis, these should be changed or avoided.
 Medical treatment for gastritis include medications to decrease the acid in the stomach
and antibiotics against the organism causing gastritis.
 Gastritis can be prevented by avoiding certain drugs, foods mentioned above, and
modifying the diet.

What is gastritis?

Gastritis is a group of diseases that cause inflammation of the lining of the stomach. Acute gastritis
(occurs suddenly) and chronic gastritis (develops slowly). The inflammation of the stomach lining is most
frequently caused by a bacterium called H. pylori. Gastritis can vary greatly from mild gastritis to severe
gastritis. Symptoms might not always be correlated with the severity of the disease.

Gastritis Causes

Gastritis is associated with various medications, medical and surgical conditions, physical stresses, social
habits, chemicals, and infections. Some of the more common causes of gastritis are listed

Medications (only the most common medications are listed)

REFERENCE: Wehbi, M. MD. Acute Gastritis. Medscape. Sep 18, 2014

http://www.emedicinehealth.com/gastritis/topic-guide.htm
Medically Reviewed by a Doctor on 8/28/2015
Medical Author: Jerry R. Balentine, DO, FACEP
Medical Editor: Bhupinder Anand, MD

 Aspirin (more than 300 drug products contain some form of aspirin)
 Nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen [Advil and others] or
naproxen)
 Prescription steroids (for example, prednisone)
 Potassium supplements
 Iron tablets
 Cancer chemotherapy medications

Swallowing chemicals or objects

 Corrosives (acid or lye)

 Swallowed foreign bodies (paper clips or pins)

Medical and surgical conditions

 People who are critically ill or injured can develop gastritis.

 After medical procedures (such as endoscopy, in which a specialist looks into the
stomach with a small lighted tube)
 After an operation to remove a part of the stomach
 After radiation treatment for cancer
 Autoimmune diseases
 Chronic vomiting

Infections

 Tuberculosis
 Syphilis
 Bacterial infections: H pylori infection is the most common.
 Viral infections
 Fungal (yeast) infections
 Parasites and worms

Other Causes

 Stress
 Alcohol consumption
 Caffeine
 Smoking
 Autoimmune gastritis: your body attacks the cells that line your stomach. This is usually
found in people with underlying autoimmune disorders.
 Eosinophilic Gastroenteritis: An uncommon form of gastritis due to eosinophilic
infiltration of the stomach wall.

REFERENCE: Wehbi, M. MD. Acute Gastritis. Medscape. Sep 18, 2014

http://www.emedicinehealth.com/gastritis/topic-guide.htm
Medically Reviewed by a Doctor on 8/28/2015
Medical Author: Jerry R. Balentine, DO, FACEP
Medical Editor: Bhupinder Anand, MD

 Bile reflux gastritis: This condition is a postgastrectomy complication leading to stomach

pain, vomiting bile and weight loss.

Gastritis Symptoms

Symptoms of gastritis do not always correspond to the extent of physical changes in the lining of
the stomach.

 The stomach lining can be examined with an endoscope, a thin probe with a tiny camera
at the end that can be inserted through the mouth into the stomach.
 Severe gastritis may be present when the stomach is viewed without any symptoms being
present.
 Conversely, severe gastritis symptoms may be present despite only minor changes in the
stomach lining.
 Elderly people in particular have a much higher likelihood of developing painless
stomach damage. They may have no symptoms at all (no nausea, vomiting, pain) until
they are suddenly taken ill with bleeding.

In people who have gastritis symptoms, pain or discomfort in the upper abdomen are the most
common symptoms.

 The pain is usually in the upper central portion of the abdomen (the "pit" of the stomach).
 Sometimes gastritis pain occurs in the left upper portion of the abdomen and in the back.
The pain seems to "go right straight through."
 People often use the terms burning, aching, gnawing, or soreness to describe the pain.
Usually, a vague sense of discomfort is present, but the pain may be sharp, stabbing, or
cutting.

Other symptoms of gastritis include the following:

 Belching: Belching usually either does not relieve the pain or relieves it only briefly.
 Nausea and vomiting: The vomit may be clear, green or yellow, blood-streaked, or
completely bloody, depending on the severity of the stomach inflammation.
 Bloating
 Feeling of fullness or burning in the upper part of the belly

In more severe gastritis, bleeding may occur inside the stomach. Erosive gastritis causes an
erosion of the gastric mucosa leading to bleeding.

Any of the following symptoms can be seen as well as those already mentioned.

 Pallor, sweating, and rapid (or "racing") heartbeat.

REFERENCE: Wehbi, M. MD. Acute Gastritis. Medscape. Sep 18, 2014

http://www.emedicinehealth.com/gastritis/topic-guide.htm
Medically Reviewed by a Doctor on 8/28/2015
Medical Author: Jerry R. Balentine, DO, FACEP
Medical Editor: Bhupinder Anand, MD

 Feeling faint or short of breath

 Chest pain or severe stomach pain
 Vomiting large amounts of blood
 Bloody bowel movements or dark, sticky, very foul-smelling bowel movements

Any or all of these symptoms can occur suddenly. This is particularly true in adults older than 65
years of age.

When to Seek Medical Care for Gastritis

See your health-care professional if your symptoms are new, long-lasting, or worsen despite self-
care.

Seek immediate medical attention if you have any of the following symptoms.

 Vomiting that does not allow the affected person to take food, fluids, and medications
 Fever with abdominal pain
 Fainting or feeling faint
 Rapid heartbeat
 Unexplained sweating
 Pallor
 Repeated vomiting of green or yellow material
 Vomiting any amount of blood
 Shortness of breath
 Chest pain

Gastritis Diagnosis

The diagnosis of gastritis may be established by a complete history and physical. Some cases
may require blood tests and other tests (endoscopy) or a consultation with a specialist (usually a
gastroenterologist).

The health-care professional first interviews the person about their symptoms, medical history,
habits and lifestyle, any medications that are taken by the patient.

 This information is enough to make the diagnosis in many people.

 Be sure to tell the doctor about all the medications the patient takes, including
nonprescription drugs, herbal and botanical preparations, and supplements such as
vitamins.
 Also report any measures the patient has taken to relieve the symptoms and how well
those measures worked.

Laboratory testing: No laboratory tests can pinpoint a diagnosis of gastritis.

REFERENCE: Wehbi, M. MD. Acute Gastritis. Medscape. Sep 18, 2014

http://www.emedicinehealth.com/gastritis/topic-guide.htm
Medically Reviewed by a Doctor on 8/28/2015
Medical Author: Jerry R. Balentine, DO, FACEP
Medical Editor: Bhupinder Anand, MD

 Often, no tests are necessary.

 If the health-care professional orders tests, it is probably to rule out certain medical
conditions that can cause gastritis or mimic gastritis.
 Once all other possibilities are ruled out, that leaves gastritis as the most likely cause of
the patient's symptoms.

The following tests are most likely to be ordered:

 H. Pylori test
 Blood cell counts (looking mostly for anemia, a low blood count)
 Liver and kidney functions
 Urinalysis
 Gallbladder and pancreas functions
 Pregnancy test
 Stool test to check for blood

X-rays films or other diagnostic images may be ordered, although they are usually not necessary.

An electrocardiogram (ECG, EKG) might be ordered if the patient's heartbeat is rapid or they are
having chest pain.

The patient may be referred to a gastroenterologist, a doctor who specializes in diseases of the
digestive system.

 The gastroenterologist may in turn recommend an endoscopy.

 During the endoscopy, a thin, flexible probe with a tiny camera at the end is passed into
the stomach for a direct look.
 At the same time, samples of the stomach lining can be taken to test for a wide variety of
conditions.

Gastritis Treatment

Once the diagnosis of gastritis has been confirmed by a medical professional, treatment can
begin. The choice of treatment depends to some extent on the cause of the gastritis. Some
treatments target the exact cause of a particular type of gastritis. Most treatments aim at reducing
stomach acid and symptoms. The patient's stomach often will heal over time if the underlying
cause is identified and corrected.

Gastritis Self-Care at Home and Home Remedies

If a person knows what causes their gastritis, the simplest approach is to avoid the cause.

REFERENCE: Wehbi, M. MD. Acute Gastritis. Medscape. Sep 18, 2014

http://www.emedicinehealth.com/gastritis/topic-guide.htm
Medically Reviewed by a Doctor on 8/28/2015
Medical Author: Jerry R. Balentine, DO, FACEP
Medical Editor: Bhupinder Anand, MD

Alcohol

 Aspirin and alcohol are the two most widely used substances that cause gastritis.
 Alcohol should be avoided if the person develops an upset stomach and nausea after drinking
alcohol.

Medications to Avoid

Sometimes a person cannot avoid certain substances that cause gastritis.

 The health-care professional may have a good reason to recommend aspirin, iron, potassium, or
some other medication that causes gastritis.
 If the person develops minor gastritis symptoms, it may be best to continue the recommended
medication and treat the gastritis symptoms.
 Consult a health-care professional before stopping any medication.

In the case of aspirin, coated aspirin may not cause the same symptoms because:

 Coated aspirin does not dissolve in the stomach.

 Check the contents of any other over-the-counter medication the patient is taking because more
than 300 medications contain aspirin in some form.

 If a person develops an upset stomach and nausea after drinking alcohol or using aspirin, these
substances should be avoided.
 Consult a health-care professional before stopping any medication.

The health-care professional may recommend that nonsteroidal anti-inflammatory drugs

(NSAIDs) such as ibuprofen (Advil, Motrin, Nuprin) be taken with food or with antacids. Doing
this may lessen the chance of developing gastritis symptoms.

Switching from aspirin or NSAIDs to another pain reliever may help as well. Acetaminophen
(Liquiprin, Tylenol, Panadol) is not known to cause gastritis.

 Talk with a health-care professional before switching to acetaminophen.

 He or she may have recommended aspirin or an NSAID for a specific purpose.

Gastritis Diet and Foods to Avoid

Changes to your diet can also help improve your symptoms. A gastritis diet needs to exclude

 spicy foods,
 fatty foods, and
 usually fried foods.

Several small meals a day also can help gastritis symptoms.

REFERENCE: Wehbi, M. MD. Acute Gastritis. Medscape. Sep 18, 2014

http://www.emedicinehealth.com/gastritis/topic-guide.htm
Medically Reviewed by a Doctor on 8/28/2015
Medical Author: Jerry R. Balentine, DO, FACEP
Medical Editor: Bhupinder Anand, MD

Gastritis Medical Treatment

The safest treatment is to avoid substances that trigger gastritis symptoms.

 Almost all health-care professionals would recommend this as the first step in preventing
gastritis.
 First, the patient has to identify the triggers of gastritis.
 Most people are aware of their triggers before seeking medical care.
 If a person does not know what triggers their gastritis, a health-care professional can
assist them in determining the triggers.

Common avoidable triggers of gastritis symptoms include the following. See the "Causes" for a
more complete list.

 Certain medications and chemicals

 Cigarette smoking
 Alcohol
 Coffee and other beverages that contain caffeine, such as cola and tea

Gastritis Medications

If gastritis symptoms continue, antacids are sometimes recommended. Three main types of
antacids are available. All three are about equal in effectiveness.

 Magnesium-containing antacids may cause diarrhea. People with certain kidney

problems should use these cautiously or not at all.
 Aluminum-containing antacids can cause constipation.
 Calcium-containing antacids have received a great deal of attention for their ability to
control stomach acid and also supplement body calcium. Calcium supplementation is
most important for postmenopausal women. Calcium-based antacids can also lead to
constipation.
 Antacids may also change the body's ability to absorb certain other medications. Only
take medications with antacids after checking with a pharmacist or doctor.
 If the patient requires an antacid more than occasionally, consult a health-care
professional as they can decide which one is best for the patient.

Stronger medications that protect the stomach's lining or lessen acid production in the stomach
are available by prescription. Talk to a health-care professional if the nonprescription
medications do not work.

Histamine (H2) blockers have received a lot of attention for stomach problems.

 Some of these medications, for example, cimetidine (Tagamet) and ranitidine (Zantac),
are available without a prescription.

REFERENCE: Wehbi, M. MD. Acute Gastritis. Medscape. Sep 18, 2014

http://www.emedicinehealth.com/gastritis/topic-guide.htm
Medically Reviewed by a Doctor on 8/28/2015
Medical Author: Jerry R. Balentine, DO, FACEP
Medical Editor: Bhupinder Anand, MD

 Histamine blockers work by reducing acid secretion in the stomach.

 This reduces gastritis pain and other symptoms.
 If a person needs one of these medications regularly, a health-care professional should be
consulted for recommendations.

Proton pump inhibitors (PPIs): These medications are very powerful blockers of the stomach's
ability to secrete acid.

 A health-care professional who prescribes one of these medications to treat the patient's
gastritis may be doing so in consultation with a gastroenterologist.
 Examples of PPIs include lansoprazole (Prevacid) and omeprazole (Prilosec, Losec).

Coating agents: These medications protect the stomach's lining.

 Sucralfate (Carafate): Coats and protects the stomach lining

 Misoprostol (Cytotec): Also protects the stomach lining. It is used as a preventive
measure for people taking NSAIDs who are at a high risk of developing stomach damage

Antibiotics: An antibiotic may be prescribed if H pylori is the cause of the patient's gastritis.

Antiemetics: Antiemetic medications help control nausea and vomiting. A number of different
antiemetics can be used to control gastritis symptoms. Some of these medications are available
by prescription for home use as well. Note that these medications do not improve the gastritis,
but rather only decrease the symptoms of gastritis.

Gastritis Follow-up

 Avoid substances that irritate the stomach or cause symptoms.

 Take all medications as prescribed by the health-care professional.
 Return for medical attention if symptoms worsen or persist.
 Report any new symptoms to a health-care professional.

Gastritis Prevention

The mainstay of gastritis prevention is to avoid those things that irritate or inflame the stomach's
lining.

 Aspirin (use coated aspirin if the person must take aspirin)

 NSAIDs such as ibuprofen (Motrin, Advil) or naproxen (Naprosyn)
 Smoking
 Caffeine and other caffeine-like substances
 Alcohol

REFERENCE: Wehbi, M. MD. Acute Gastritis. Medscape. Sep 18, 2014

http://www.emedicinehealth.com/gastritis/topic-guide.htm
Medically Reviewed by a Doctor on 8/28/2015
Medical Author: Jerry R. Balentine, DO, FACEP
Medical Editor: Bhupinder Anand, MD

If the patient's health-care professional has prescribed a medication that they think is causing
gastritis symptoms, talk to the doctor before you stop taking the medication. The medication may
be very important for the patient's health.

Gastritis Prognosis

Most people recover from gastritis. Depending on the many factors that affect the stomach
lining, gastritis symptoms may flare-up from time to time. Overall, gastritis is a common ailment
that responds well to simple treatments.

On occasion, rare forms of gastritis can be serious or even life-threatening. Severe, ongoing
symptoms or internal bleeding should alert a health-care professional to search for a more serious
underlying cause.

REFERENCE: Wehbi, M. MD. Acute Gastritis. Medscape. Sep 18, 2014

http://www.emedicinehealth.com/gastritis/topic-guide.htm