The most common symptom of gastritis is epigastric pain which is often described as burning by patients. Sometimes, this burning pain extends up to the sternum. There may also be nausea and vomiting, feeling of fullness, easy satiety, hiccups and flatulence. Symptoms like bleeding occur when complications set in and they could be accompanied by symptoms of anemia. They usually manifest as blood in stool or coffee stained vomitus [5].

• Pain

  The pain is usually in the upper central portion of the abdomen (the "pit" of the stomach). Gastritis pain occurs in the left upper portion of the abdomen and in the back. [web.archive.org]

  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." [emedicinehealth.com]

  Symptoms of gastritis Symptoms of gastritis can include: abdominal pain or discomfort constant pain between the navel and lower ribs nausea, sometimes with vomiting poor appetite belching, bloating, or a feeling of fullness in the abdomen that is made [health.harvard.edu]

  Regular use of pain relievers. Certain over-the-counter and prescription pain medications can irritate or inflame the lining of your stomach and small intestine. [tmphysiciannetwork.org]

• Anemia

  Deficiency of vitamin B12 eventually leads to a condition called pernicious anemia. The patient presents with: tiredness anemia (rarely) symptoms in the limbs such as numbness or tingling The diagnosis is easily confirmed by blood tests. [ddc.musc.edu]

  Chronic gastritis caused by pernicious anemia is treated with vitamin B12. Irritating drugs that cause the disease are discontinued. Gastritis Additional Information [britannica.com]

  All 3 patients remained asymptomatic and their anemia was alleviated with continued administration of oral iron. [ncbi.nlm.nih.gov]

  Blood Test: The doctor may check your red blood cell count to see whether you have anemia, which means that you do not have enough red blood cells. In gastritis, anemia can be caused by bleeding from the stomach. [verywellhealth.com]

• Weakness

  Then there is a case of a man with chronic gastritis, weak heart, lumbago, and sciatica. For some reason very little attention is paid to chronic gastritis and duodenal ulcer. [dictionary.cambridge.org]

  I ate very little but nevertheless felt bloated, had a white coating on my tongue, a burning sensation at my stomach exit and felt very weak. These problems were worse in spring and autumn. [bruno-groening.org]

  Weaknesses in the barrier allow your digestive juices to damage and inflame your stomach lining. A number of factors can contribute to or trigger gastritis, including: Bacterial infection. [web.archive.org]

  Backflow of bile into the stomach (bile reflux) Cocaine abuse Eating or drinking caustic or corrosive substances (such as poisons) Extreme stress Viral infection, such as cytomegalovirus and herpes simplex virus (more often occurs in people with a weak [nlm.nih.gov]

• Asymptomatic

  Depends on the etiology (see below). asymptomatic epigastric pain/tenderness nausea and vomiting loss of appetite Etiology infection: H. pylori (most common) systemic illness: trauma and burns pharmacological/medication: NSAIDs autoimmune caustic ingestion [radiopaedia.org]

  Most patients are asymptomatic. Diagnosis is by endoscopy. Treatment is eradication of H. pylori and sometimes acid suppression. [web.archive.org]

  Many cases are asymptomatic, but dyspepsia and GI bleeding sometimes occur. Diagnosis is by endoscopy. Treatment is directed at the cause but often includes acid suppression and, for Helicobacter pylori infection, antibiotics. [merckmanuals.com]

  Many cases are asymptomatic, but dyspepsia and gastrointestinal bleeding sometimes occur. Diagnosis is by endoscopy. Treatment is directed at the cause but often includes acid suppression and, for Helicobacter pylori infection, antibiotics. [msdmanuals.com]

• Fatigue

  This can lead to fatigue and being short of breath with physical activity. Diagnosing gastritis Your story of your symptoms and a physical examination may be all a doctor needs to diagnose gastritis. [health.harvard.edu]

  We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: January 31, 2019 [patientslikeme.com]

  The fatigue and the gassy back-to-back “burpscapade” begins, and you know your night is done. You excuse yourself, grab your keys, and head home to rest. [goodmenproject.com]

  When to seek medical advice Call your healthcare provider right away if any of these occur: Fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider Stomach pain that worsens or moves to the lower right part of belly Extreme fatigue [fairview.org]

  Persistent bleeding can lead to symptoms of anemia, including fatigue, weakness, and light-headedness. Gastritis can lead to stomach ulcers (gastric ulcers), which may cause the symptoms to get worse. [merckmanuals.com]

• Vomiting

  Consultation with a physician for further investigations and more sophisticated treatments will be necessary if symptoms do not settle quickly, or if any vomit contains blood. [ddc.musc.edu]

  Common symptoms can include: loss of appetite pain in the upper abdomen just under the ribs nausea or indigestion hiccups vomiting blood in the vomit blood in the bowel actions, if the stomach lining has ulcerated (this turns stools black and is called [betterhealth.vic.gov.au]

  Nausea and vomiting: The vomit may be clear, green or yellow, blood-streaked, or completely bloody, depending on the severity of the stomach inflammation. [web.archive.org]

  Causes Gastritis Gastritis can be caused by a variety of reasons irritation due to chronic vomiting, excessive alcohol use, chronic vomiting, stress, or the use of certain medications or other anti-inflammatory drugs. [tmphysiciannetwork.org]

• Nausea

  Other symptoms can include: nausea and vomiting bloating and gas weight loss and/or loss of appetite Chronic Gastritis Symptoms In the vast majority of cases, chronic gastritis causes no symptoms. [ddc.musc.edu]

  Depends on the etiology (see below). asymptomatic epigastric pain/tenderness nausea and vomiting loss of appetite Etiology infection: H. pylori (most common) systemic illness: trauma and burns pharmacological/medication: NSAIDs autoimmune caustic ingestion [radiopaedia.org]

  Gastritis can be either acute (with severe attacks lasting a day or two) or chronic (with long-term appetite loss or nausea). In many cases, gastritis has no symptoms (asymptomatic). [betterhealth.vic.gov.au]

• Abdominal Pain

  Symptoms Gastritis Nausea or recurrent upset stomach Abdominal bloating Abdominal pain Vomiting Indigestion Burning or gnawing feeling in the stomach between meals or at night Hiccups Loss of appetite Vomiting blood or coffee ground-like material Black [tmphysiciannetwork.org]

  The chief symptoms are severe upper-abdominal pain, nausea, vomiting, loss of appetite, thirst, and diarrhea; the illness develops suddenly and subsides rapidly. [britannica.com]

  It is unclear whether H. pylori infection without ulcers causes abdominal pain. [rileychildrens.org]

• Loss of Appetite

  Depends on the etiology (see below). asymptomatic epigastric pain/tenderness nausea and vomiting loss of appetite Etiology infection: H. pylori (most common) systemic illness: trauma and burns pharmacological/medication: NSAIDs autoimmune caustic ingestion [radiopaedia.org]

  The chief symptoms are severe upper-abdominal pain, nausea, vomiting, loss of appetite, thirst, and diarrhea; the illness develops suddenly and subsides rapidly. [britannica.com]

  Gastritis and an ulcer are conditions that affect the stomach and small intestine, and they share many symptoms, such as abdominal pain, nausea, vomiting, loss of appetite and weight loss. There are many differences, though. [tmphysiciannetwork.org]

• Diarrhea

  She had repeated upper gastrointestinal bleeding from a Dieulafoy lesion of the fornix, but had no symptoms of malabsorption or diarrhea. [ncbi.nlm.nih.gov]

  The chief symptoms are severe upper-abdominal pain, nausea, vomiting, loss of appetite, thirst, and diarrhea; the illness develops suddenly and subsides rapidly. [britannica.com]

  […] some infections may get worse with anti-diarrhea medicines. [medicalnewstoday.com]

  Noninflammatory diarrhea, which is typically less severe than inflammatory diarrhea, causes large, watery stool with cramping but no blood; fecal leukocytes are absent. [contemporaryclinic.pharmacytimes.com]

  If you cannot keep liquids down, have continuous vomiting, or frequent diarrhea, see a doctor. [medicinenet.com]

Laboratory tests

• Complete blood count
• Coagulation profile
• Urea breath test
• Liver function test
• Renal function test
• Stool for occult blood
• Gastric biopsy 
• Pregnancy test
• Helicobacter pylori stool antigen test
• Test for gall bladder and pancreatic function

Imaging

• Plain abdominal X-ray
• Double contrast barium studies
• CT scan
• Endoscopy

• Gastric Lesion

  The objective of this study was to compare the expression of miRNA-146a and miRNA-155 in gastric lesions of paediatric and adult patients with different pathologies and in Mongolian gerbils (Meriones unguiculatus) infected with H. pylori 26,695. [ncbi.nlm.nih.gov]

  This drug is effective in healing the gastric mucosal lesions without altering the therapeutic benefits of the non-steroidal anti-inflammatory drugs given to arthritis patients. [rarediseases.org]

  Lesion of Chronic Gastritis With Acute Exacerbation or Gastric Ulcer Completed NCT01190657 Phase 4 Selbex;Selbex 11 A Phase IV Study to Evaluate the Efficacy and Safety of Vitamin B12 Contains Extract of Lamb's Stomach in Treatment of Chronic Atrophic [malacards.org]

The treatment of gastritis can either be medical or surgical. Medical treatment involves identifying the root cause of gastritis and eradicating it as well as instituting supportive treatment. Supportive treatment involves setting up an IV line to replace lost fluid and electrolytes for patients who are vomiting and blood transfusion for anemic patients [6].

Drugs treatments are targeted at reducing acid secretion, increasing mucosal resistance and eradicating infectious organisms. They include:

• Antacids to neutralize the acidity of the stomach.
• H2 blockers like cimetidine and ranitidine.
• Proton pump inhibitors like omeprazole.
• Antibiotics include metronidazole, amoxicillin, clarithromycin, and tetracycline. They are usually used in combination.
• Other antibiotics for target specific causes like anti-tuberculosis drugs for gastritis caused by mycobacterium.

Surgical intervention is rare and mostly involves resection and it is limited to cases of phlegmonous gastritis [7].

The prognosis of simple gastritis is generally very good. Once the causative organism is identified and treated, the individual makes good recovery. However, when it becomes complicated by hemorrhage, perforation, or in minute cases gastric cancer, the clinical outcome becomes worse.

The cause could be infective or non-infective. The infective causes could be bacteria, Helicobacter pylori is the commonest of this group. It is also the commonest cause of gastritis. Others infective causes include viruses, fungi, mycobacteria and parasites.

Non-infective causes include drugs, the most implicated drugs here are non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. Other non-infective causes are stress, food poison, food allergy, radiation, bile, autoimmune diseases, ischemia, uremia and trauma. It could also be autoimmune [2].

Gastritis is a curable condition and it is treatable as soon as the cause can be determined. The incidence ad prevalence as well as distribution among age, race and gender is largely dependent on the cause of gastritis. The acute form affects both sexes equally and affects all age groups. It is has a slightly higher prevalence in blacks and Hispanics.

The chronic form also has no sexual predilection and affects all age groups although it usually begins to manifest after childhood.
It is important to note that about half of the world’s population is infected with Helicobacter pylori which is the number one cause of gastritis with the underdeveloped world contributing a large percentage. Not all of them are however symptomatic [3].

The gastric mucosa is usually kept intact by an equilibrium of the aggressive stomach acid forces and the forces of the protective gastric mucosal barrier. As a rule, anything that increases the force of the acid or reduces the defenses of the barrier such that the acid overwhelms the protective barrier would lead to gastritis and this could happen suddenly or over time. 

Examples of substances that increase the acidic contents are bile and pancreatic acids. Occasionally, they reflux into the stomach overwhelming the stomach mucus. NSAIDs act by inhibiting prostaglandin synthesis. Prostaglandin is necessary for formation of the gastric mucosal lining. Effects like radiation and ischemia affect the mucus producing cells in the stomach wall by killing them thereby reducing the capacity of the stomach to defend itself against acids.

Helicobacter pylori has a different pathway however. When a person is infected, the bacteria finds its way to the stomach wall where it colonizes and begins to form a substance known as urease. Urease is an enzyme that protects the bacteria from stomach acids by breaking urea down to the more alkaline ammonia while it causes a severe inflammatory reaction in the stomach wall [4].

• Avoid long term use of NSAIDs.
• Avoid hot and spicy foods.
• Avoid foods that irritate the stomach.
• Avoid prolonged hunger by eating small meals frequently.
• Reduce stress.
• Exercise regularly.
• Maintain a good BMI.
• Route of transmission of Helicobacter pylori is thought to be from fecal to the oral route so good food hygiene like hand washing before a meal is advocated [8].

Gastritis is a fairly common condition and is usually classified as acute or chronic and erosive or non-erosive. It can either affect the whole stomach or part of it. However, all cases present with the same set of symptoms, regardless of the underlying etiology [1].

Definition

Gastritis is a condition that result when the walls of the stomach are either partially or wholly inflamed.

Cause

It could be acute (occurring suddenly) or chronic (occurring over time) and causes of this include infections from bacteria, the commonest one being Helicobacter pylori. Other infective agents could be viruses, fungi, parasites and mycobacterium. Other causes are prolonged used of the pain relieving NSAIDs like ibuprofen, exposure to radiation, injuries, stress and food allergy and food poison. Sometimes the body cells attacking itself can lead to gastritis [9].

Signs and symptoms

The most common symptom is a burning pain at the upper part of the abdomen, it can also be felt in the middle of the chest. This pain is usually worse after eating. Other symptoms are nausea, vomiting, feeling of full abdomen, inability to eat normally, and passing of gas. Sometimes, vomitus or stool might be blood stained and this is a sign of internal bleeding.

Diagnosis

Many tests would be carried out. They include blood tests, urine tests and stool tests to test for bacteria and blood. Imaging tests like X-ray (including special x-rays) and CT scan might be carried out. A live view of the stomach wall might also be done using an endoscope.

Treatment

Treatment is usually with drugs and often requires a combination of drugs. Surgery is required only in rare types and when complication arises [10].

1. Drepper MD, Spahr L, Frossard JL. Clopidogrel and proton pump inhibitors--where do we stand in 2012?. World J Gastroenterol. May 14 2012;18(18):2161-71
2. Saad RJ, Schoenfeld P, Kim HM, Chey WD. Levofloxacin-based triple therapy versus bismuth-based quadruple therapy for persistent Helicobacter pylori infection: a meta-analysis. Am J Gastroenterol. Mar 2006;101(3):488-96.
3. Chen CH, Yang JC, Uang YS, Lin CJ. Differential inhibitory effects of proton pump inhibitors on the metabolism and antiplatelet activities of clopidogrel and prasugrel. Biopharm Drug Dispos. Jul 2012;33(5):278-83.
4. Feldman. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 7th ed. 2002:810-823.
5. Gisbert JP, Pajares JM. Diagnosis of Helicobacter pylori infection by stool antigen determination: a systematic review. Am J Gastroenterol. Oct 2001;96(10):2829-38.
6. Soltermann A, Koetzer S, Eigenmann F, et al. Correlation of Helicobacter pylori virulence genotypes vacA and cagA with histological parameters of gastritis and patient's age. Mod Pathol. Aug 2007;20(8):878-83.
7. Odze RD, Goldblum JR. Inflammatory disorders of the stomach. In: Surgical Pathology of the GI Tract, Liver, Biliary Tract, and Pancreas, Lash RH, Lauwers GY, et al. (Eds), Saunders, Philadelphia 2009. p.285.
8. van der Hulst RW, van der Ende A, Dekker FW, et al. Effect of Helicobacter pylori eradication on gastritis in relation to cagA: a prospective 1-year follow-up study. Gastroenterology 1997; 113:25.
9. Morgner A, Bayerdörffer E, Meining A, et al. Helicobacter heilmannii and gastric cancer. Lancet 1995; 346:511.
10. Hazell SL, Lee A, Brady L, Hennessy W. Campylobacter pyloridis and gastritis: association with intercellular spaces and adaptation to an environment of mucus as important factors in colonization of the gastric epithelium. J Infect Dis 1986; 153:658.