Chronic gastritis is a long-lasting inflammation of your stomach lining that affects millions of people worldwide. Unlike acute gastritis that develops suddenly, chronic gastritis develops slowly and can persist for months or years if left untreated.

Understanding this condition is important because it can lead to serious complications, including stomach ulcers and an increased risk of stomach cancer. The good news is that with proper treatment, most people can manage their symptoms effectively and prevent these complications.

What Is Chronic Gastritis?

Your stomach lining (called the mucosa) normally protects your stomach from the strong acid it produces to digest food. When this protective lining becomes inflamed and stays inflamed for a long time, you develop chronic gastritis.

The inflammation can affect different parts of your stomach:

  • Antrum (lower part of the stomach)
  • Corpus (upper body of the stomach)
  • Both areas (pangastritis)

The location and severity of inflammation determine your symptoms and the best treatment approach.

Types of Chronic Gastritis

There are several types of chronic gastritis, each with different causes and characteristics.

Non-Atrophic Gastritis

This is the most common type, where the stomach lining is inflamed but the acid-producing glands are still working normally. It’s also called chronic superficial gastritis.

Atrophic Gastritis

In this more serious type, the inflammation has damaged the stomach lining so much that it can’t produce enough acid and digestive enzymes. The stomach lining becomes thin and loses its normal structure.

Special Forms

Other types include:

  • Chemical gastropathy: Caused by bile reflux or certain medications
  • Autoimmune gastritis: When your immune system attacks your stomach cells
  • Eosinophilic gastritis: A rare type involving certain white blood cells

What Causes Chronic Gastritis?

Several factors can lead to chronic gastritis.

Helicobacter Pylori Infection

Most cases are caused by a bacteria called Helicobacter pylori (H. pylori). This bacteria is found in over 90% of people with chronic gastritis in some populations (1).

H. pylori spreads through:

  • Contaminated food or water
  • Contact with saliva or other body fluids from infected people
  • Poor sanitation

Other Common Causes

  • Long-term NSAID use: Pain medications like ibuprofen and aspirin can irritate the stomach lining
  • Excessive alcohol consumption: Alcohol can erode the protective stomach lining
  • Bile reflux: When bile backs up from your small intestine into your stomach
  • Autoimmune conditions: Your immune system mistakenly attacks healthy stomach cells
  • Chronic stress: Can increase stomach acid and reduce protective factors
  • Smoking: Damages the stomach lining and increases acid production

Symptoms of Chronic Gastritis

Many people with chronic gastritis have no symptoms at all. When symptoms do occur, they may include:

Common Symptoms

  • Upper abdominal pain or discomfort: Often described as burning, gnawing, or aching
  • Bloating: Feeling uncomfortably full during or after meals
  • Nausea: With or without vomiting
  • Loss of appetite
  • Early satiety: Feeling full after eating only a small amount (2)
  • Indigestion: General discomfort after eating
  • Weight loss: Due to poor appetite or eating less to avoid symptoms
Warning
Seek immediate medical attention if you experience severe stomach pain, vomiting blood, black or tarry stools, or unexplained weight loss. These could indicate serious complications.

How Is Chronic Gastritis Diagnosed?

Diagnosing chronic gastritis requires a combination of tests and examinations.

Endoscopy

This is the most important test. A thin, flexible tube with a camera is passed down your throat to examine your stomach lining. During the procedure, your doctor can:

  • See inflammation, erosions, or other changes
  • Take tissue samples (biopsies) for testing
  • Check for H. pylori infection

Tests for H. Pylori

Several tests can detect this bacteria:

  • Breath test: You drink a special solution and breathe into a bag
  • Stool test: Checks for H. pylori proteins in your stool
  • Blood test: Looks for antibodies to H. pylori
  • Biopsy urease test: Tests stomach tissue directly

Blood Tests

These can check for:

  • Anemia (low red blood cells)
  • Vitamin B12 levels
  • Antibodies that suggest autoimmune gastritis
  • Pepsinogen levels (markers of stomach function)

New research shows that blood tests measuring pepsinogen and other markers can diagnose atrophic gastritis with 71% sensitivity and 98% specificity (3).

Treatment Options

Treatment depends on what’s causing your gastritis and how severe it is.

Treating H. Pylori Infection

If you have H. pylori, getting rid of it is the main goal. Standard treatment includes:

Triple therapy (for 7-14 days):

  • A proton pump inhibitor (like omeprazole)
  • Two antibiotics (usually amoxicillin and clarithromycin)

Quadruple therapy (if triple therapy fails):

  • A proton pump inhibitor
  • Bismuth
  • Two different antibiotics

Studies show that 10-day sequential therapy achieves eradication rates of 84.2%, while 14-day modified bismuth quadruple therapy achieves 76.5% (4).

Successfully eliminating H. pylori has been shown to:

  • Significantly reduce inflammation
  • Improve stomach lining health
  • Prevent progression to more serious conditions
  • Reduce the risk of stomach cancer

Medications to Reduce Acid

Proton pump inhibitors (PPIs) like omeprazole or esomeprazole are the most effective acid reducers. They help heal the stomach lining and relieve symptoms.

H2 blockers like ranitidine or famotidine are another option, though less powerful than PPIs.

Important Note
Long-term PPI use in people with H. pylori infection may worsen inflammation in the corpus (upper stomach), so H. pylori should be treated first (5).

Medications to Protect the Stomach Lining

Rebamipide is a protective medication that can help improve atrophic gastritis and intestinal metaplasia. Studies show it significantly improves symptoms and reduces inflammation markers (6).

Sucralfate forms a protective coating over damaged areas of the stomach lining.

Treating Nutritional Deficiencies

Chronic gastritis, especially atrophic gastritis, can cause:

  • Vitamin B12 deficiency: May need injections or high-dose supplements
  • Iron deficiency: Iron supplements may be needed
  • Other vitamin deficiencies: A multivitamin may help

Research shows that vitamin C supplementation may help protect against the progression of stomach lining damage in people with H. pylori infection (7).

Alternative and Complementary Treatments

Several complementary approaches have shown promise:

Traditional Chinese Medicine (TCM): Studies show that certain TCM formulas can be more effective than conventional Western medicine. One analysis found that TCM groups had significantly higher overall clinical efficacy with an odds ratio of 4.65 compared to routine pharmacotherapy (8).

Acupuncture: Research demonstrates that acupuncture can significantly improve symptoms. One study showed a 92.5% improvement rate with acupuncture compared to 75% with conventional medication (9).

Probiotics: May help restore healthy gut bacteria, especially during and after antibiotic treatment for H. pylori.

Tip
Always discuss complementary treatments with your doctor. They can be used alongside conventional medicine but shouldn’t replace proven treatments, especially for H. pylori infection.

Dietary Management

What you eat can significantly affect your symptoms.

Foods to Avoid

  • Spicy foods: Can irritate the inflamed stomach lining
  • Acidic foods: Citrus fruits, tomatoes, vinegar
  • Coffee and alcohol: Stimulate acid production
  • Fatty and fried foods: Slow digestion and may worsen symptoms
  • Carbonated beverages: Can cause bloating and discomfort
  • Processed foods: Often contain additives that may irritate

Helpful Dietary Habits

  • Eat smaller, more frequent meals
  • Choose lean proteins like chicken, fish, and tofu
  • Cook vegetables rather than eating them raw
  • Include probiotic foods like yogurt
  • Stay hydrated with water
  • Eat slowly and chew thoroughly

Complications of Untreated Chronic Gastritis

Without proper treatment, chronic gastritis can lead to serious problems.

Peptic Ulcers

The ongoing inflammation can create open sores in your stomach or small intestine. These can cause severe pain and may bleed.

Stomach Cancer

Chronic atrophic gastritis, especially when it affects the corpus (upper stomach), significantly increases your risk of developing stomach cancer. This risk is particularly high in people with intestinal metaplasia (when stomach cells change to resemble intestinal cells) (10).

The good news is that treating H. pylori can reduce this risk. Studies show that successful H. pylori eradication significantly improves the stomach lining, particularly in the corpus, though changes in the antrum may be less dramatic (11).

Nutritional Problems

Chronic gastritis can interfere with the absorption of important nutrients:

  • Vitamin B12 deficiency: Can cause anemia, fatigue, and nerve problems
  • Iron deficiency anemia: Leading to weakness and fatigue
  • Other nutrient deficiencies: Including folate and vitamin D

Stomach Bleeding

Severe inflammation can cause bleeding, which may be slow and chronic (leading to anemia) or sudden and severe (a medical emergency).

Prevention Strategies

While you can’t prevent all cases of chronic gastritis, you can reduce your risk.

Preventing H. Pylori Infection

  • Practice good hygiene: Wash hands thoroughly, especially before eating
  • Drink clean, safe water
  • Ensure food is properly cooked and stored
  • Avoid sharing utensils or drinking from the same glass

Lifestyle Changes

  • Limit alcohol: Or avoid it completely if you have gastritis
  • Quit smoking: Smoking damages the stomach lining
  • Manage stress: Try relaxation techniques, exercise, or counseling
  • Use NSAIDs carefully: Only when necessary, with food, and under medical supervision
  • Maintain a healthy diet: Rich in fruits, vegetables, and whole grains

Living with Chronic Gastritis

Managing chronic gastritis is an ongoing process, but most people can live normal, healthy lives with proper treatment.

Follow-up Care

Regular check-ups are important, especially if you have atrophic gastritis. Your doctor may recommend:

  • Periodic endoscopy to monitor changes
  • Blood tests to check for nutritional deficiencies
  • H. pylori testing to ensure it hasn’t returned

When to See Your Doctor

Contact your healthcare provider if you experience:

  • Worsening or new symptoms
  • Signs of bleeding (black stools, vomiting blood)
  • Unexplained weight loss
  • Persistent fatigue or weakness
  • Difficulty swallowing
Note
If you have atrophic gastritis with intestinal metaplasia, your doctor may recommend surveillance endoscopy every 3-5 years to check for precancerous changes.

The Bottom Line

Chronic gastritis is a manageable condition when properly diagnosed and treated. If you suspect you have chronic gastritis, don’t ignore your symptoms. See your healthcare provider for proper evaluation and treatment. With the right approach, you can control your symptoms and protect your long-term health.

Was this article helpful?