What is Gastritis: Causes, Symptoms, Diet, Home Remedies

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What is Gastritis

While the term gastritis covers a broad spectrum of entities, in simple words the term refers to inflammation of mucosal lining of stomach. The clinical presentation of the disease is more or less the same in each type, with severe nagging pain occurring in bursts or episodes as the most common presenting complaint; however the etiology and histological characteristics differ in each type.

While all age groups are affected by gastritis, the incidence of the H.pylori infection increases with age. Around 30-50% of adults are affected in the United States, but the prevalence of the infection is higher in developing countries. The most important predictor of the infection is the socioeconomic difference, making the infection extremely common in:

• Large crowded households
• Areas with poor sanitation

Gastritis can be sudden in onset (acute gastritis) or a long-lasting and recurring type (chronic). Gastritis affects people of all age. While, it may not be a serious issue in most of the people, it can lead to ulcers, perforation and at times cancer.

Causes of Gastritis

A weakened or a damaged mucosal lining allows digestive juices to irritate stomach eventually resulting in inflammation, swelling and pain. A number of factors are responsible for occurrence of gastritis:

• Bacterial infection: A bacterial infection, most frequently with helicobacter pylori (H.pylori) is one of the most common causes of gastritis. Two-thirds of people already have the organism in their body, but for most it does no harm. Food, water and utensils are the most common way through which the bacteria gain access, which is why it’s more prevalent in communities with poor hygiene and sanitation. There are other causative organisms (rare) as well:
• H helimanii
• Streptococci
• Staphylococci
• Proteus species
• Clostridium specieis
• Tuberculosis
• Secondary syphilis

Healthcare providers believe that susceptibility to get infected could be:

• Inherited
• Linked to smoking
• Associated with stress
• Drugs: yet another common cause of gastritis is the frequent use of NSAIDs, pain relievers and drugs, which have a tendency to cause gastritis if they reach toxic levels (in patient with hepatic and renal impairment) like;
• Aspirin
• Ibuprofen
• Naproxen
• Cocaine
• Colchicines
• Iron
• Chemotherapeutic agents
• Alcoholic beverages
• Viral infections like CMV
• Fungal infections like candidiasis, histoplasmosis and phycomycosis
• Parasitic infections (anisakidosis)
• Acute stress or shock
• Radiation
• Allergy
• Food poisoning
• Bile reflux
• Ischemia or a reduced blood supply to stomach may induce damage as well
• Trauma

Apart from the causes listed above, there are certain factors that may increase the risk of developing gastritis in some people slightly more as compared to the rest of the population. These factors are:

• Older age- you have an increased risk of gastritis with an increasing age because;
• Stomach lining thins with age
• There’s an increased risk of H.pylori infection
• Increased risk of autoimmune disorders
• Excessive alcohol use- is more likely to cause gastritis
• Stress- either due to trauma, burns, a major surgery or a severe infection increases the risk of gastritis
• Co-morbids- there is an association between gastritis and medical conditions like;
• HIV/AIDS
• Crohn’s disease
• Parasitic infections
• Regular intake of pain relievers- the more frequently you use pain relievers (NSAIDs) the more chances you have of developing gastritis.
• Steroid intake

Gastritis Types

• Acute Gastritis- as suggested by its name is an inflammation of sudden onset. Acute gastritis, depending on the clinical presentation and the type f mucosal lining damage may further be divided into four types;
• Catarrhal gastritis– most commonly results from intake of strong alcohol or an infectious disease and is characterized by;
• Hypertrophy of stomach lining
• Inflammation
• Excessive mucus secretion
• Fibrinous gastritis– characterized by significantly damaged mucosal layer of stomach, while rest of the layers remain undamaged. It may be due to;
• Strong acid ingestion
• Mercuric chloride ingestion
• Severe infections
• Necrotic gastritis– often leading to a full-thickness necrosis of stomach wall followed by perforation is a consequence of ingesting;
• Strong acid
• Strong base
• Salts of heavy metal
• Suppurative gastritis– also known as phlegmonous gastritis is characterized by purulent inflammation of gastric wall (full-thickness) and can present in three forms (diffuse, mixed and localized). Diffuse being the most common type, slowly involves all gastric layers and progresses to gangrene. It occurs as a complication of;
• Stomach ulcer
• Cancer
• Severe infection
• Chronic Gastritis- is the long-lasting type of gastritis, which keeps recurring and may be due to several factors at a time. Due its gradual nature of progression and recurrence, the gastric glandular cells undergo a transformation into fibrous and interstitial tissues hindering stomach’s function. Chronic gastritis can be broadly categorized under three types:
• Type A: also known as autoimmune gastritis involves an attack by the body’s immune cells destroying the parietal cells responsible for gastric acid secretion. As a result there is;
• A decrease or complete absence of stomach acid (achlorohydria)
• An increased risk of cancer if left untreated for a long period of time
• A need to undergo drug therapy for the rest of the life due to reduced acidic content of stomach
• Megaloblastic anemia due to reduced production of intrinsic factor (required for binding and absorption of vitB12) by the parietal cells.
• Type B: or the much talked about bacteria-induced gastritis, of which the H.pylori is the most common cause. While there may not be many symptoms in most of the people, a small amount of population does develop peptic ulcers. Due to the constant inflammatory process, people with this type are likely to have:
• Adenocarcinoma
• B-cell gastric lymphoma (rare case)
• Type C: is the chemically-induced gastritis that occurs either due to irritants like drugs (NSAIDs) or bile. It’s two types are;
• Biliary reflux gastritis (caused by reflux of bile often seen in patients who have undergone partial gastric resection)
• Gastritis caused by NSAIDs- is another type involving the lowering of prostaglandins that protect mucosa from HCl damage
• Other types of chronic gastritis: gastritis may occur due to other causes as well and on this list we have the following types;
• Eosinophilic gastritis: characterized by eosinophilic infiltration of stomach wall, is often a hyperallergic reaction to pathogens. Patient may also suffer from;
• Asthma
• Seasonal allergies
• Eczema
• Other atopic conditions
• Collagenous gastritis: is marked by deposition of collagen under mucosa. Etiology is unknown
• Immunodeficiency- results in idiopathic form of gastritis in around 40% of patients.
• Radiation-induced gastritis-results when radiation is focused on the upper part of abdomen

Gastritis Symptoms

As already mentioned, severe epigastric discomfort or heartburn is with what patients present most commonly. Many patients may not experience any pain at all. Other common symptoms that may accompany this epigastric discomfort are:

• Nausea
• Recurrent stomach upset
• Abdominal pain
• Bloating
• Vomiting
• Vomiting blood
• Indigestion
• Burning sensation between meals or at night
• Loss of appetite
• Hiccups
• Black, tarry stools.

Physical examination of the patient may not reveal much, except for mild abdominal tenderness. However, with progression and development of complications, there may be a variety of findings on physical examination.

Gastritis Diagnosis

Gastritis workup requires a combination of lab studies, imaging studies, endoscopy and histologic examination. The following lab tests may be advised by your healthcare professional:

• Complete blood count (to look for anemia, indicating GI bleeding)
• Liver function tests
• Renal function tests
• Pregnancy test
• Stool for blood

Imaging reveals four signs that are always consistent with acute gastritis, no matter what the underlying cause is. These four radiological signs are:

• Thick folds

Folds greater than 5mm in caliber, if found in a symptomatic patient, often indicate an H. pylori infection.

• Inflammatory nodules

These nodules result in a bumpy appearance and are thought to represent healed erosions with edema. Seen most often in distal stomach, the characteristic nodules are:

• Small
• Tapering onto adjacent mucosa
• Lined up on the folds of antrum
• Erosions

One of the most specific signs, gastric erosions are often seen on or near the greater curvature of the stomach. Best shown on a double-contrast examination, these erosions may be liner or serpiginous.

• Coarse area gastric

Inflammatory swelling is reflected by enlarged area gastric, often 1-3mm in size, which is not really specific to a particular cause.

Tests specifically done to detect H.pylori are also present, since this is one of the most frequently found reasons behind gastritis. These tests are:

• Rapid urease test
• Bacterial culture H.pylori
• Biopsy for H.pylori detection
• pylori stool antigen test
• Urea breath test
• Serologic assays

Endoscopy is another common procedure done.

Gastritis Complications

While the condition of majority improves with treatment and changes in diet and lifestyle, chronic gastritis that keeps recurring and is not managed appropriately may lead to complications with negative outcome. Therefore persistent symptoms and discomfort despite trying home remedies and treatment should be conveyed to the doctor as soon as possible. Complications of gastritis include:

• Peptic ulcer
• Bleeding
• Gastric cancer
• Anemia
• MALT lymphoma
• Gastric scarring
• Stricture formation
• Gastric outlet obstruction due to stricture and scar formation
• Dehydration
• Renal problems
• Death

Managing Gastritis

Gastritis management begins at the level of preventive measures and progresses to making changes in lifestyle, eating habits, taking medicines and most importantly keeping a tab on whether the management is appropriate or not, because once the underlying issue is treated successfully, the symptoms disappear on their own.

Gastritis Diet

People suffering from gastritis and peptic ulcers need to follow a special diet plan, which includes all the foods that are safe for them to eat and excludes the food items that increase acid secretion and trigger symptoms like:

• Heartburn
• Indigestion
• Epigastric discomfort

While one finds a specific food as an aggravating factor, the other person may not complain of any symptoms after consuming it. Not everyone gets affected in the same way. It’s therefore of utmost importance to make a diet or meal plan of your own that suits your body and needs.

Diet plans are especially a bonus for those who are not compliant when it comes to taking medicines or those with poor eating habits. Let us now take a look at what should be included in the diets of gastritis patients;

Fruits: packed with all, macronutrients as well as micronutrients, fruits tend to be one of the best choices. Fruits are a good source of vitamins, minerals, fiber, anti-oxidants and phytochemicals. 2-4 servings of fruits per day would be more than enough (one medium piece of fresh fruit). While canner fruits and juices are a good option too, there is absolutely nothing that can beat fresh fruits! Options you have are:

• Apples
• Pears
• Peaches
• Bananas
• Melon
• Kiwi
• Grapes

Vitamin C, ascorbic acid (found in berries, citrus fruits and tomatoes) plays an important role in protecting gastric mucosa from injurious insults. A review studying vitamin C and gastritis in fact associated ascorbic acid deficiency with all forms of gastritis [1]. Vitamin C is an important phytonutrient and evidence suggests that ascorbic acid may play a protective role against H. pylori gastritis and gastric cancer in part by significantly reducing inflammation-associated oxidative damage to the gastric mucosa [2].

Vegetables: pretty much like fruits, vegetables are also teeming with all the necessary nutrients and including them in your diet is a good way of ensuring a balanced and nutritious diet. While you may have to go through the trial and error procedure to see which one suits you best, cruciferous vegetables like broccoli, Brussels and cabbage have been shown to be effective in reducing colonization and attenuating gastritis in mice and individuals infected with H.pylori [3].

It is the isothiocynate sulforaphane (SF) content of the vegetable broccoli, which is responsible for the bactericidal action against H.pylori. According to the study, 48 H.pylori infected were randomly fed broccoli sprouts for 8 weeks. This particular group when compared with the placebo showed reduced:

• Urease levels with urea breath test
• pylori stool antigen
• Pepsionigen I and II (markers of gastric inflammation)

Once the treatment was discontinued, the levels were restored to their original value after 2 weeks. The study concluded that daily intake of SF- rich broccoli sprouts for 8 weeks:

• Decreased H.pylori colonization in mice
• Improves infection sequelae in mice and humans
• Enhanced chemoprotection of mucosa against H.pylori induced oxidative stress

Folic acid: folic acid rich food substances can also be of great help because according to a study folic acid may be used to treat atrophic gastritis by either preventing or reversing pre cancerous lesions [4]. Again dark green and leafy vegetables are an excellent source of folic acid along with nuts, corns and carrots.

Yogurt: certain yogurts have an active culture that helps in regulating the balance between good and bad bacteria. Yogurt containing lactobacillus cultures have specifically shown to;

• Lower infection levels
• Boost effectiveness of conventional antibiotics and treatments for gastritis and ulcers in patients already on standard triple therapy.

A study conducted to investigate the effect of specially designed fermented milk product with probiotic Lactobacillus casei DN-114 001 on H.pylori eradication in children on standard triple therapy, involved randomizing of 86 symptomatic H.pylori positive children to receive:

• Standard triple therapy (2 antibiotics and PPI)
• Triple therapy and fermented milk product

H.pylori status was then assessed after 4 weeks using two non-invasive tests and it was found out that lactobacillus casei DN-114 001 confers and enhanced therapeutic benefit on H.pylori eradication in children with gastritis on triple therapy [5].

Furthermore, people consuming such milk products, especially yogurt are less likely to experience side effects like nausea and vomiting. Probiotics like lactobacillus:

• Increase gut’s ability to absorb and digest nutrients
• Heal the digestive system
• Reverse gut damage
• Ease gastritis symptoms

Garlic: due to its broad-spectrum anti-microbial and anit-fungal activity, H.pylori tends to be sensitive to it. If you’re suffering from chronic heartburn, then you might have to start with small amount of garlic and then gradually increase it. Garlic has been used worldwide to fight bacterial infections and Louis Pasteur was the first one to explain antibacterial effect of garlic and onion juices.

The oil and water-soluble organosulfur compounds responsible for the typical odor of garlic are behind its therapeutic effects as well. Garlic:

• Exhibits activity against gram negative and gram positive bacteria
• Active against enterotoxic coli and other pathogenic intestinal bacteria
• Has an effect on resistant strains of micro organisms as well

The anti-bacterial activity of garlic against H.pylori has been well demonstrated in a clinical study as well [6].

Gastritis. Foods to Avoid

You’re very well aware of what can be helpful in your battle against stomach acid. Now let us take a look at what you should specifically avoid. It wouldn’t be hard for you to tell what aggravates your pain, since gastritis symptoms often begin after eating. The following food items and beverages in general trigger an episode of the much dreaded nagging pain.

Avoiding high salt diet could reduce your chances of developing or aggravating gastritis. According to a research a high-salt diet in experimental animals and humans can cause atrophic gastritis [7], and is considered as a gastric tumor promoter as well. It has an influence by:

• Enhancing H.pylori colonization
• Potentiating H.pylori associated carcinogenesis by:
  • Inducing proliferation
  • Glandular atrophy
  • Pit cell hyperplasia

Foods to avoid:

• Chocolate
• Hot peppers
• Pasta
• Dairy (other than organic yogurt)
• Corn
• Coffee
• Soy
• Sodas
• Energy drinks
• Processed food
• Sweets
• Alcohol
• Spicy food
• Beans

A better way of finding what disturbs your tummy is to make a food diary. Simply note down everything you eat followed by the timing. Likewise, monitor the time your pain begins and now compare both the routines. Once you’ve found out the triggers of your pain, you can easily avoid them.

Home Remedies for Gastritis

• Ginger- due to its antibacterial and anti-inflammatory properties, ginger may very well treat infections and get rid of symptoms like;
• Indigestion
• Bloating
• Stomach pain
• Nausea

Either the form of taking ginger capsules, or chewing raw ginger, it can affect gastritis symptoms and help in reducing them. However, it also has a blood-thinning effect and people with fluctuating blood pressure should be cautious.

• Green tea- a home remedy that has been proved by research and studies. Green tea according to a study has protective against over gastric mucosa against chronic gastritis. Furthermore, it also protects against stomach cancer [8].
• Carom seeds- the nature’s very own antacid that helps in assuaging acidity, nausea, indigestion as well as bloating. 1tsp of a mixture of the following ingredients with a glass of warm water 3 times a day can work wonders. Keep drinking till gastritis symptoms are relieved.

– 1tsp carom seeds + bit of black pepper + dried ginger

• Yogurt – yet another effective remedy for gastritis. As already mentioned yogurt with probiotics and live cultures may work wonders. 2-3 cups of yogurt with live cultures should be taken daily till symptoms are relieved.
• Peppermint- known for its ant-bacterial, anti-spasmodic and anti-inflammatory properties, peppermint has a soothing effect on the gastric lining and reduces indigestion, nausea as well as heart burn. Whether you like chewing fresh peppermint or adding it to you salads, soups and smoothies, the choice is yours.
• Fennel seeds – are highly recommended as a remedy for gastritis. Not only do the seeds soothe digestive system but also have a relaxing effect on the muscles. Their anti-bacterial, anti-inflammatory and anti-spasmodic properties make them an excellent choice for assuaging symptoms like nausea, vomiting, indigestion and heartburn. Try chewing fennel seeds properly and thoroughly after meals to see the effects.

Do’s and Don’ts

Dieting strategies are as important as the diet itself. The following tips might come in handy, but then again trial and error will best help you to make adjustments in diet plan and routine.

• Regularity in meals is important but too frequent meals may cause acidity.
• Fat-free or low fat dairy products should be consumed in order to control acid production, however the serving should be less than 3 per day
• Go for food items that can be easily digested
• Eat slowly and chew properly to not only make digestion easy but prevent gastritis too.
• Avoid overloading your stomach
• Avoid spicy food
• Avoid foods that lead to gas production
• Try to manage stress
• Change your lifestyle
• Make a proper eating routine

Gastritis Myths

Being an extremely common occurrence, heartburn and Epigastric tenderness have been experienced by almost everyone at some point of life. Myth peddlers continue to support ideas and reasoning that research and study is yet to prove. Let this section of the article be a myth buster of all such concepts.

Myth #1- Gastritis treatment is a long-term treatment

Only if you aren’t following your doctor’s properly! With appropriate medications, abstinence from aggravating factors and most importantly a healthy eating routine, you’re certain to assuage gastritis and all its symptoms in a short period of time.

PS- you will have to follow the bland diet routine for some time though.

Myth#2- Bland diet routine is not necessary

This leaves common sense far behind. When every single symptom of gastritis arises from what you eat, then continuing the same diet doesn’t make sense at all, right? spicy and oily food aggravates your condition, stop eating it, give it a shot! Bland diet does make difference because when you make changes in your diet, you start working at the level of roots.

Myth# 3- Citrus fruits could be a cause of gastritis

Citrus fruits, being acidic in nature can trigger GERD, producing pretty much the same symptoms as gastritis (heartburn and Epigastric discomfort) but they can NOT be a cause of gastritis. In fact, citrus fruits being a rich source of vitamin C and ascorbic acid offer gastric mucosa protection against insults. However, again watch your own diet. Don’t just stop eating it because it happens to trigger an attack in your friend. If it doesn’t disturb you, keep eating it but in moderation.

Myth#4- Gastritis is caused by stress

Again, stress is not the root cause, it can only aggravate the condition, which is why stress management and lifestyle modification form an important part of gastritis management. A sudden and drastic change in emotions like getting excited or depressed may have an effect on stomach acid secretion and this is how an attack may be triggered.

When to seek medical assistance?

While home remedies may offer a quick fix for most of the problems, a serious underlying pathology needs to be seen by a doctor. Make sure you seek medical attention immediately if the following symptoms are experienced:

• Vomiting that makes intake of fluids, food and medicines impossible
• Unconsciousness or feeling that you may pass out\
• Fever with abdominal pain
• Increased heartbeat (tachycardia)
• Pallor
• Profuse sweating
• Green or yellow vomitus (repeatedly)
• Breathlessness
• Chest pain

All these symptoms might be an indication of an emergency that requires immediate attention and home remedies might not be effective or a wise choice here.

Gastritis Treatment

Gastritis treatment is aimed at resolving the underlying issue. Once the etiology is confirmed, the treatment is then accordingly. Surgical intervention is indicated only for the treatment of:

• Phlegmonous gastritis involving resection of the area affected.

General measures taken during gastritis management are:

• Administration of fluids and electrolytes in patients vomiting
• Discontinuing the drugs that cause gastritis

Pharmacotherapy depends on the specific systemic disease due to which gastritis has developed. Drugs given for gastritis include:

• Antacids – given as a prophylactic measure. Aluminium and magnesium containing drugs help in reliving symptoms of gastritis
• H2 blockers- These drugs competitively inhibit histamine at H2 receptors, which plays an important role in gastric acid secretion. H2 receptors suppress gastric acid output.
• Proton pump inhibitors (PPI)- are effective in completely inhibiting gastric acid secretion by inhibiting the proton (acid) pump in parietal cells. PPI:
  • Are most effective amongst drugs
  • Have a longer duration of action
• Antibiotics- play a vital role when the bacterial infection (H.pylori most commonly) is the etiology. Since the organisms have developed significant resistance, single antibiotic is not recommended anymore. Therapies now include:
  • Dual therapy (PPI + amoxicillin or PPI + clarithromycin)
  • Triple regimens are preferred in clinics now (PPI/ bismuth based drug + clarithromycin + amoxicillin/metronidazole)
  • Quadruple therapy ( 2 antibiotics + antisecretory agent + bismuth based drug) is also very effective but then has more adverse effects as well.

The choice of drugs is guided by the following criteria:

• Cost of the regimen
• Various toxicities of the medicines
• Anti-microbial resistance
• Patient compliance

Summary

While the mortality and morbidity of the disease is clearly guided by the underlying etiology, most of the gastritis cases are treatable with simple home remedies, preventive measures and appropriate treatment. In order to manage the disease well, understanding the disease is of vital importance.

Educating patient about the consequences of not taking preventive measures and not following a proper diet and meal plan forms an important part of gastritis management. Whether home remedies would be your solution or professional medical treatment, depends on the intensity and severity of symptoms as well as the duration. Either ways, you need to watch the symptoms like a hawk so that gastritis may be appropriately managed.

References

[1] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874117/#R66
[2] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4024801/
[3] http://www.ncbi.nlm.nih.gov/pubmed/19349290
[4] http://www.ncbi.nlm.nih.gov/pubmed/12667380
[5] http://www.ncbi.nlm.nih.gov/pubmed/16082279
[6] http://jn.nutrition.org/content/131/3/1106S.full
[7] http://www.ncbi.nlm.nih.gov/pubmed/10519391
[8] http://www.ncbi.nlm.nih.gov/pubmed/11304697