What causes Gastritis? Symptoms, treatments, and foods to avoid
Gastritis is a very common condition involving inflammation of the stomach lining. It’s often confused with indigestion, as the two conditions cause similar symptoms. But while the occasional episode of indigestion or upset stomach is normal, you may have gastritis if you’re affected by persistent symptoms, including:
Pain and burning sensations in the upper abdomen just below the breastbone, which may be worse when you eat.
Bloating, hiccuping or burping.
Nausea, vomiting or retching.
Loss of appetite.
Feeling very full quickly after eating.
Gastritis also shouldn’t be confused with gastroenteritis. Gastritis is when your stomach lining becomes inflamed, but gastroenteritis is inflammation of the stomach and bowel. Gastroenteritis is caused by an infection, but gastritis isn’t always infection related, and can be triggered by other things. The symptoms are also not quite the same, with gastroenteritis mainly causing diarrhoea and vomiting.
Gastritis can affect different people in different ways, with symptoms ranging from mild to severe. Some people with gastritis don’t experience any symptoms, in which case the condition is only detected through an examination or tests. There are also different types:
This form of gastritis develops gradually and causes long-term symptoms. Atrophic gastritis is also a form of chronic gastritis. If you have chronic gastritis, you may also have a higher risk of developing complications such as a stomach ulcer, stomach polyps (small growths) or stomach tumours (some of which can be cancerous).
If you have more sudden symptoms that tend to come and go and last for short periods of time, you may have acute gastritis.
Should you see your GP?
The good news is most cases of gastritis are mild and get better without any treatment. But if you have any of the following, see a health professional for advice:
Severe stomach pain.
Pain or other indigestion-type symptoms that last for more than a week.
Gastritis symptoms that start after you’ve taken prescription or over-the-counter medicines.
Vomiting blood (the colour of the vomit may be like coffee).
Blood in your stools (your stools may look black).
Unexplained weight loss.
Your doctor may use a number of methods to diagnose gastritis, the most common of which is a simple examination of your abdomen and taking a history of your symptoms.
If you don’t recover quickly or you’re experiencing severe pain, you may be referred for other tests, such as a gastroscopy (where a tiny telescope is passed through to your stomach via your oesophagus/gullet). Other tests include a barium swallow, where you drink a barium solution before having an X-ray, and a breath test that checks for infection (this involves drinking a tasteless liquid then blowing into a bag).
What causes gastritis?
Gastritis develops when the digestive tract becomes weakened, specifically the lining that keeps digestive acids from damaging the stomach.
When you eat, food passes through your oesophagus into your stomach. To help with the digestion of your food and to kill any germs it may contain, your stomach produces acid. At the same time, some of the cells in your stomach lining produce mucous that acts as a protective barrier. This barrier stops the acid corroding your stomach lining, and also protects the lining of the top part of the small intestine (duodenum).
However, when the mucous barrier becomes weakened, the stomach lining can be damaged by the acid, and as a result may become inflamed.
There are several reasons why the mucous barrier may weaken, including the following:
Helicobacter pylori (H. pylori) bacteria
According to the NHS, many people become infected with H. pylori bacteria without realising it, since such infections don’t always cause any symptoms. They can, however, cause chronic inflammation of the stomach lining, especially in older people. If you have a H. pylori infection you have it for life, unless you’re treated. People with gastritis caused by H. pylori infection may not experience any gastritis symptoms.
Taking anti-inflammatory medicines
If you take aspirin, ibuprofen or other painkillers classed as non-steroidal anti-inflammatory drugs (NSAIDs) – for joint problems, for instance, or muscular problems such as back pain – it can affect your stomach’s mucous barrier.
Illness or injury
A major injury, illness or surgery can trigger acute gastritis, though experts aren’t clear why this can happen (some believe it could be caused by reduced blood flow to the stomach). High levels of chronic stress may also be involved.
Drugs and alcohol
Excessive drinking and using cocaine may damage stomach lining. Some experts also believe smoking may contribute to gastritis.
Less frequently this can trigger gastritis when the immune system attacks healthy tissue in the stomach lining. This may be more common in those who already have an autoimmune disorder, such as type 1 diabetes or Hashimoto’s thyroid disease.
As you get older your stomach lining naturally gets thinner, which may at least partly explain why gastritis is often seen in middle-aged and older people.
Besides H. pylori bacteria, other types of bacteria as well as viruses, parasites and fungi can occasionally cause gastritis. It’s also thought that some other conditions that affect the digestive system may be linked to gastritis, such as coeliac or Crohn’s disease.
How is gastritis treated?
If you’ve been diagnosed with gastritis, your doctor may recommend antacid medicines to help neutralise the acid in your stomach. These are available over the counter, and in mild cases they can offer fast relief. If you decide to try antacids, it’s best to take them with food or soon after eating. However, don’t take any other medicines within two to four hours of taking antacids, as they can affect the way some other medicines work.
Antacids are safe for most people to take, but they’re not suitable for everyone, including women who are pregnant or breastfeeding, people with high blood pressure or heart failure, and those who have liver or kidney disease. If you’re affected by any of these factors, speak to a pharmacist or your GP before taking antacids.
If your symptoms don’t ease sufficiently after taking antacids, you may be advised to take other over-the-counter medicines that are often used to treat gastrointestinal problems, including medicines called histamine 2 blockers and proton pump inhibitors, both of which are also available on prescription.
H. pylori treatments
If your test results show you have a H. pylori infection that’s causing gastritis symptoms, the infection will usually clear up by taking two antibiotic medicines along with a proton pump inhibitor to reduce the level of acid in your stomach (this helps the antibiotics to work more effectively in the stomach).
This is called combination therapy – or sometimes eradication therapy or even triple therapy – because any one of these medicines on its own isn’t effective. According to Patient, combination therapy clears up H. pylori in up to nine out of 10 cases when taken correctly. If the first course of combination therapy doesn’t work, a second course usually clears the infection.
However, if you don’t treat a H. pylori infection, you will have it for life.
Meanwhile, if your gastritis is caused by an anti-inflammatory medicine such as aspirin or ibuprofen, your GP will usually advise you to stop taking it or offer you an alternative. At the same time you may have to take antacids or other acid-suppressing medicines to stop your stomach producing acid, which can give the inflammation in your stomach time to heal.
However, don’t stop taking any medicine without getting advice from your GP first. You may, for instance, need aspirin to help prevent blood clots, which means you could be left without protection if you stopped taking it. If this is the case your GP may recommend that you take acid-suppressing medicines indefinitely, rather than stop taking aspirin.
How your lifestyle can help
There are several changes you can make to your lifestyle that may help ease the symptoms of gastritis. The first thing you should look at is your diet:
Avoid irritating foods
Certain foods can irritate your stomach lining more than others. These can include the following:
Fruit juices (particularly citrus)
Some acidic foods (including tomatoes and other fruits such as lemons, limes, grapefruit, oranges, grapes and pineapples)
Fried or fatty foods
Highly processed foods or foods with lots of synthetic additives
Sugary foods and drinks
Eat more stomach-friendly foods
It’s not just about what you shouldn’t eat. If you have gastritis, eating more foods that are high in fibre, foods that are low in fat and foods that are alkaline rather than acidic may also be helpful. Most vegetables and some fruits are classed as alkaline foods, as are soya foods, nuts, seeds and legumes. Fermented foods such as yoghurt, sauerkraut, kefir, kombucha and kimchi are also often recommended.
If you’re not sure which foods have a negative or beneficial effect on your symptoms, try keeping a food diary to better understand how what you eat affects your gastritis. Keep your diary for two to four weeks, writing down everything you eat and drink, when you eat and drink them and when you experience gastritis symptoms. After a few weeks you should start to notice links between certain foods and when your symptoms start.
Drink more water
An over-acidic stomach can often be relieved simply by drinking a glass of water. Drinking around eight glasses of water a day may help keep your stomach’s acid levels more normal.
Have smaller, more frequent meals
Many nutrition experts recommend having several smaller meals every two to four hours instead of having one or two big meals a day as a way to relieve gastritis symptoms.
Meanwhile, other things you can do that may be helpful in reducing gastritis symptoms include the following:
Give up smoking.
Lose weight if you need to.
Try relaxation methods such as meditation, deep breathing, yoga or t’ai chi to help relieve stress.
Stay active (try to do at least 30 minutes of exercise five times a week).
Natural support for gastritis
In addition to the above, the following nutritional supplements may be beneficial to those with gastritis:
Many plant-based remedies are thought to be effective against H. pylori infection, including garlic (i). It’s thought that H. pylori bacteria are very sensitive to garlic. However, eating garlic can trigger heartburn symptoms in some people, while others don’t like the taste. A garlic supplement designed to reduce any aftertaste may be the ideal solution.
Probably best known as a curry spice, turmeric is fast becoming a popular nutritional supplement thanks to its active ingredient curcumin. Curcumin is thought to have anti-inflammatory properties, which may be helpful if you have gastritis. At least one study also suggests curcumin may be effective against H. pylori bacteria, particularly when used in conjunction with conventional combination therapy (ii).
Thought to help promote a healthy intestinal bacterial environment, products containing live (or ‘friendly’) bacteria such as L acidophilus may be helpful for those who have gastritis caused by H. pylori infection. There is evidence to suggest live bacteria may suppress H. pylori (iii) and reduce gastric inflammation (iv), while other studies have found live bacteria may reduce antibiotic-associated gastrointestinal side effects in those having combination therapy (v).
Live bacteria are found in a range of foods and drinks such as live yoghurt, sauerkraut, miso and kefir, but supplements may be a better way of making sure you get a decent amount.
High-strength fish oils
The omega-3 fatty acids EPA and DHA that are found in fish oil are widely thought to have anti-inflammatory properties, which explains why many nutritional therapy practitioners recommend fish oil supplements for inflammatory conditions such as gastritis. There’s also some evidence that omega-3 fatty acids may help reduce H. pylori-associated gastric problems (vi).
Cinnamon may also be useful if you have gastritis caused by certain types of micro-organisms such as fungi, as it’s thought they have anti-fungal properties.
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