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Occasional pain or discomfort in the upper abdomen can easily be attributed to dietary errors. However, if the unpleasant sensations keep returning, you should not get used to them: this may be a sign of chronic gastritis, which requires diagnosis and properly selected treatment.

In this article, we will explain why the disease develops and which symptoms may accompany it. We will also describe how it is diagnosed and treated and how to adjust your diet.

What is chronic gastritis

Chronic gastritis is long-term inflammation of the stomach lining that develops gradually and may persist for many years. Unlike an acute process, it does not occur suddenly and often causes no noticeable discomfort for a long time. At the same time, persistent inflammation can change the structure of the lining, weaken its protective properties, and affect stomach function.

The disease often has a fluctuating course: periods of exacerbation alternate with remission, when the symptoms become less pronounced or disappear. However, the absence of complaints does not always mean that the stomach lining has fully recovered.

Types of chronic gastritis

Chronic gastritis is divided into types depending on what caused the inflammation of the stomach lining. Type A has an autoimmune origin, type B is associated with the H. pylori bacterium, and type C is associated with prolonged exposure to irritants. Determining the type is important because each one requires a different approach to treatment.

Type A chronic gastritis

In type A gastritis, the immune system mistakenly damages cells in the stomach lining that are involved in the production of hydrochloric acid and the absorption of vitamin B12. As a result, gastric acid levels may decrease, while the lining becomes thinner over time and performs its functions less effectively.

Autoimmune inflammation usually develops slowly and may not cause noticeable discomfort for a long time. Therefore, the severity of the symptoms does not always indicate how much the condition of the stomach lining has changed.

Type B chronic gastritis

Type B chronic gastritis is the most common form of the disease. It is caused by Helicobacter pylori — a bacterium that lives in the stomach lining and sustains long-term inflammation.

At first, the changes more often develop in the lower part of the stomach, located near the transition to the duodenum. If the inflammation mainly affects this area, it is defined as chronic antral gastritis. Over time, the process may spread to other parts of the stomach.

Type C chronic gastritis

Type C develops when the stomach lining remains in contact with irritating substances for a long time. This may occur due to the reflux of bile from the duodenum, the regular use of certain painkillers, or exposure to alcohol.

Such irritation gradually weakens the natural protection of the lining and makes it more vulnerable to damage. Unlike types A and B, this form is not associated with an autoimmune process or bacterial infection.

Oxford Medical doctors recommend not trying to determine the type of the disease based solely on the nature of pain, heartburn, or other sensations. Different forms may have similar manifestations, while the approaches to their treatment differ.

Forms of chronic gastritis according to the nature of the lesion

Forms of chronic gastritis according to the nature of the lesion

In addition to the cause of the disease, chronic gastritis is classified according to the changes that occur in the stomach lining. The inflammatory process may be superficial, accompanied by the formation of erosions, or lead to gradual atrophy of the lining. This classification shows how severe the damage is and whether the lining retains its ability to protect the stomach wall and produce components of gastric juice that are necessary for digestion.

Form of the disease Changes that occur Features
Chronic superficial gastritis The inflammation affects the upper layer of the stomach lining without significant thinning. The structure of the lining is largely preserved, so this form is also called non-atrophic gastritis.
Chronic erosive gastritis Shallow areas of damage — erosions — form on the lining. They do not penetrate the stomach wall as deeply as ulcers. Erosions may bleed, especially if there are many of them or if the irritating factor continues to act.
Chronic atrophic gastritis The lining gradually becomes thinner, and the number of cells involved in the production of gastric juice decreases. Atrophic changes may affect individual areas or a significant part of the stomach lining.

The superficial form does not necessarily progress to the atrophic form: the course of the disease depends on its cause, the duration of the inflammatory process, and the timeliness of treatment.

Causes of chronic gastritis

According to the National Institute of Diabetes and Digestive and Kidney Diseases, H. pylori is one of the most common causes of gastritis. Less commonly, inflammation develops due to an autoimmune reaction or prolonged exposure to substances that irritate the stomach lining.

The main causes of the disease include:

  • H. pylori infection — the bacterium may remain in the stomach lining for a long time and sustain the inflammatory process;
  • an autoimmune disorder — the immune system mistakenly damages cells in the stomach lining (it is more common in people with type 1 diabetes and autoimmune thyroid diseases);
  • long-term use of nonsteroidal anti-inflammatory drugs, including ibuprofen, diclofenac, or acetylsalicylic acid;
  • reflux of bile from the duodenum into the stomach;
  • regular consumption of large amounts of alcohol;
  • Crohn’s disease, celiac disease, and certain other conditions accompanied by inflammation of the digestive tract;
  • radiation therapy and chemotherapy;
  • viral, fungal, or parasitic infections, which mainly occur in people with significantly weakened immune systems.

Oxford Medical doctors explain that spicy foods, coffee, or irregular meals do not usually cause chronic inflammation on their own. However, they may worsen discomfort if the stomach lining is already damaged.

Chronic gastritis: symptoms of the disease

Chronic gastritis may remain asymptomatic for years. When symptoms occur, they often resemble ordinary indigestion and periodically become less or more pronounced. The nature of the symptoms depends not only on the activity of the inflammation but also on acidity, gastric motility, and concomitant digestive system diseases, which may affect a person’s well-being at different times.

According to Mayo Clinic, typical manifestations include:

  • aching or burning pain in the upper abdomen, which may become less or more intense after eating;
  • heaviness and a feeling of fullness in the stomach;
  • feeling full quickly even after a small portion;
  • nausea, sometimes accompanied by vomiting;
  • loss of appetite;
  • heartburn and belching.

Chronic gastritis in the exacerbation stage causes more frequent or severe discomfort. Pain may occur after every meal or on an empty stomach, while nausea, heaviness, and a feeling of fullness may persist for several hours.

Oxford Medical doctors explain that patients also ask which symptom is most characteristic of chronic gastritis with increased gastric secretory function. Most often, it is a burning pain in the upper abdomen that occurs on an empty stomach or some time after eating. It may be accompanied by heartburn and acid belching.

The severity of symptoms does not always correspond to the extent of damage to the stomach lining. In particular, atrophic changes are sometimes detected in patients who do not have persistent pain or other noticeable complaints.

Complications of chronic gastritis

Complications of chronic gastritis

Without treatment, long-term inflammation may gradually damage the stomach lining and affect the absorption of iron and vitamin B12. The consequences depend on the cause and form of the disease: erosive changes increase the risk of bleeding, while atrophic changes increase the risk of anemia and precancerous changes. At the same time, timely treatment can significantly reduce the risk of their further development in most patients with gastritis.

Possible complications of the disease include:

  • erosions and ulcers — develop when the lining loses its ability to fully protect the stomach wall from acid;
  • gastric bleeding — may develop when blood vessels in the area of an erosion or ulcer are damaged;
  • iron deficiency anemia — may result from minor but prolonged blood loss or impaired iron absorption;
  • vitamin B12 deficiency — is primarily characteristic of the autoimmune atrophic form and may eventually lead to pernicious anemia;
  • intestinal metaplasia — a change in the cells of the stomach lining in which they acquire properties characteristic of the intestinal lining;
  • an increased risk of gastric neoplasms — adenocarcinoma, MALT lymphoma, and, in the autoimmune form, certain neuroendocrine tumors.

According to the American Gastroenterological Association, atrophic gastritis is a precancerous condition. This does not mean that the patient will necessarily develop stomach cancer. The risk increases when atrophy is extensive, intestinal metaplasia develops, and H. pylori infection persists for a long time.

Diagnosis of chronic gastritis

Diagnosis begins with a consultation with a gastroenterologist. The doctor performs an examination and palpation of the abdomen, identifies areas of tenderness, assesses the patient’s general condition, and then develops an examination plan.

The diagnosis of chronic gastritis may include:

  • Gastroscopy — an endoscopic examination of the stomach. A thin, flexible endoscope with a camera is inserted through the mouth into the stomach, allowing the doctor to examine the lining of the esophagus, stomach, and duodenum. The procedure can reveal inflammation, erosions, ulcers, and atrophic changes.
  • Biopsy — the collection of several small tissue samples from the lining during gastroscopy. Examination of the collected material helps assess the severity of inflammation and confirm atrophy, intestinal metaplasia, or dysplasia.
  • H. pylori tests — a breath test, a stool antigen test, or examination of material obtained during a biopsy. After treatment of the infection, the breath test or stool test is repeated to check the result.
  • Laboratory tests — a complete blood count and measurements of ferritin, iron, and vitamin B12 levels. If the autoimmune form is suspected, tests for antibodies to gastric parietal cells and intrinsic factor are also performed.
  • Fecal occult blood test — prescribed if bleeding from an erosion or ulcer is suspected.
  • Barium X-ray of the stomach — an additional examination during which a series of X-rays is taken after the patient drinks a contrast agent. The method helps detect deformities and narrowing of the stomach, as well as ulcerative defects.

Gastroscopy and biopsy provide the main information about the condition of the stomach lining, while laboratory tests help determine the cause of the disease and detect anemia or deficiencies of iron or vitamin B12.

How to treat chronic gastritis

Treatment of chronic gastritis is primarily aimed at the cause of the disease. If it is not eliminated, medications may only temporarily reduce pain, heartburn, or nausea. Therefore, the treatment regimen differs for H. pylori infection, autoimmune inflammation, bile reflux, and medication-related damage to the stomach lining.

The main treatment approaches include:

  • If H. pylori is detected, eradication therapy is prescribed. It includes a medication that reduces acidity, several antibacterial agents, and, in some regimens, a bismuth preparation. The course most often lasts 14 days.
  • If chronic gastritis with increased acidity is diagnosed, proton pump inhibitors or H2-receptor blockers may be prescribed. They reduce hydrochloric acid production and create conditions for the lining to recover.
  • For erosions, gastroprotective agents may also be used — medications that protect damaged areas of the lining and promote their healing.
  • If the disease is associated with long-term use of nonsteroidal anti-inflammatory drugs, the doctor reviews their dosage, duration of use, or the possibility of replacement.
  • For bile reflux, medications may be prescribed to normalize gastric motility and reduce the irritating effects of bile.
  • In the autoimmune form, vitamin B12 and iron levels are monitored. Any identified deficiency is corrected with appropriate medications.

The gastroenterologist determines the specific medications, their combination, and the duration of treatment individually for each patient. Taking antibiotics or acid-reducing medications without medical supervision may complicate further treatment.

The duration of gastritis treatment depends on its cause and the extent of damage to the lining. H. pylori eradication therapy usually lasts 14 days, while medications for healing erosions and controlling acidity may be prescribed for 4–8 weeks. In the autoimmune form, monitoring and correction of deficiencies may be long-term.

Oxford Medical doctors recommend undergoing a follow-up test after H. pylori treatment. It is performed no earlier than four weeks after completing antibiotics and at least two weeks after discontinuing proton pump inhibitors.

The answer to whether chronic gastritis can be cured depends on its form. In cases of H. pylori infection, eliminating the bacterium helps stop the inflammatory process, while superficial changes and erosions may heal. In cases of an autoimmune process, pronounced atrophy, or intestinal metaplasia, treatment is aimed at limiting further changes, correcting deficiencies, and regularly monitoring the condition of the stomach lining.

Diet for chronic gastritis

Diet for chronic gastritis

A diet for chronic gastritis is intended to reduce stomach irritation and discomfort after eating. There is no universal menu suitable for every patient: the diet is selected based on the form of the disease, acidity, and the body’s response to individual foods. Diet does not eliminate the cause of inflammation or replace treatment, but it helps control symptoms, especially during an exacerbation.

The main dietary principles include:

  • Eat small portions 4–5 times a day.
  • Avoid overeating and long intervals between meals.
  • Have dinner 2–3 hours before bedtime.
  • Choose boiled, stewed, and baked dishes.
  • Avoid food that is too hot or too cold.
  • Eat slowly and chew food thoroughly.

This routine does not overload the stomach and helps prevent increased discomfort after eating.

During an exacerbation, the diet may include:

  • Oatmeal, rice, or buckwheat porridge.
  • Light vegetable or cereal soups.
  • Boiled or baked lean meat.
  • Low-fat fish.
  • An omelet or boiled eggs.
  • Stewed or baked vegetables.
  • Bananas and baked apples.
  • Low-fat fermented dairy products if they are well tolerated.

After your condition improves, the diet is gradually expanded. Following a strict diet for a long time without a valid reason is unnecessary because excessive restrictions may lead to nutrient deficiencies.

If chronic hyperacid gastritis is accompanied by heartburn and acid belching, it is advisable to limit foods that aggravate these symptoms. Alcohol, strong coffee, carbonated drinks, spicy seasonings, acidic foods, and fatty and fried dishes most often provoke discomfort.

Oxford Medical doctors recommend keeping a food diary for 1–2 weeks: record the foods you eat, portion sizes, and how you feel after meals. This will help identify individual trigger foods and adjust your diet without unnecessary restrictions.

Chronic gastritis can be successfully controlled, and in many cases its cause can be eliminated. To achieve this, it is important to undergo an examination, follow the prescribed treatment regimen, and adjust your diet according to your doctor’s recommendations.

The information in this article is provided for informational purposes and is not a guide to self-diagnosis or self-treatment. If symptoms of the disease occur, you should consult a doctor.

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