Acute Gastritis · What Is It, Causes, Symptoms, Diagnosis, and More

Acute gastritis refers to a sudden onset of inflammation of the stomach lining, also known as the gastric mucosa. In contrast, chronic gastritis refers to long-term inflammation of the gastric mucosa.   

With acute gastritis, a disruption in the gastric mucosa triggers an inflammatory immune response that attracts white blood cells to the site of injury. If the mucosal damage is severe enough, acute gastritis can progress to erosive gastritis, which consists of shallow lesions of the stomach lining (i.e., gastric erosions), painful ulcerations or sores, and small areas of bleeding within the mucosa.  

Although the term “gastritis” is sometimes used as a synonym for “upset stomach” or “indigestion,” it most accurately refers to the evidence of inflammatory cells in a stomach biopsy, usually obtained through an upper endoscopy. An endoscopy is a minimally invasive procedure that uses a flexible tube attached to a small camera to look at the inside of a part of the body, like the gastrointestinal tract. If no inflammation is seen on the gastric biopsy, then the term gastropathy can be used instead.  

Acute gastritis occurs as a result of weakness or injury to the gastric mucosa, which can allow stomach acids to damage and inflame the lining. There are several risk factors for damage to the gastric mucosa, including use of certain medications, infections, acute stress, and dietary factors.  

One of the main causes of acute gastritis is frequent or long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen. These medications interfere with the protective mechanisms of the gastric mucosa, leading to a decreased production of gastric mucus and increased vulnerability to gastric acid. As a result, excessive use of NSAIDs can increase the risk of developing acute gastritis.  

Bacterial infection by Helicobacter pylori (H. pylori) is another common cause of gastritis. H. pylori is a spiral-shaped bacteria that colonizes the stomach of many individuals. In most people, early infection by H. pylori doesn’t cause many symptoms and usually goes unnoticed. However, long-lasting or chronic infection by H. pylori can lead to persistent inflammation of the gastric mucosa, as well as loss of the normal glandular structure of the stomach. Eventually, this can increase the risk of developing other digestive problems, such as stomach ulcers and stomach cancer.   

Acute gastritis can also occur as a result of extreme physiological stress, often due to major surgery, trauma, severe burns, or severe illnesses. In some cases, the stomach ulcers associated with specific types of physiological stress are given specific names, such as Curling ulcers, which are associated with severe burns, and Cushing ulcers that are associated with brain injury.  

Additional risk factors for developing acute gastritis include autoimmune conditions, increased intake of alcohol, a high salt diet, and tobacco use, all of which can irritate the gastric mucosa. More rarely, the ingestion of harsh chemicals can lead to severe mucosal damage due to a direct gastric injury.  

Acute gastritis usually lasts for a short period of time, typically days or weeks, depending on the cause. In most cases, it can resolve spontaneously; when the offending cause is removed (e.g., stop NSAIDs); or with short term treatment with a proton pump inhibitor.  

In other cases, however, acute gastritis can lead to recurrent or long-term inflammation of the gastric mucosa. With time, chronic gastritis can increase the risk of developing other complications, such as stomach ulcers, upper gastrointestinal bleeding, and certain types of stomach cancer. 

Initially, a history is taken to identify possible causes of acute gastritis, such as long-term use of NSAIDs, excessive alcohol consumption, or H. pylori infection. A physical examination will follow and can help aid in determining differential diagnoses. In some cases, when a clear cause of inflammation can be identified clinically, such as a history of long-term use of NSAIDs, no additional tests are usually required. 

However, if the diagnosis is uncertain, or if bleeding occurs, additional work-up is necessary, such as an upper endoscopy to directly visualize the gastric mucosa and obtain a biopsy to examine.  

Treatment of acute gastritis is aimed at relieving the underlying cause of inflammation. Some cases of acute gastritis resolve without any treatment, while others require treatment via lifestyle changes or medications. 

Proton pump inhibitors, such as omeprazole or pantoprazole, may aid in relieving the symptoms of gastritis by helping decrease gastric acid production which allows for healing of the gastric mucosa. Proton pump inhibitors, along with a combination of various antibiotics, can also be used to treat H. pylori infection. Additionally, other medications including H2 blockers (e.g., famotidine) and some over-the-counter medications, such as bismuth subsalicylate and calcium carbonate have been used in the symptom relief and treatment of gastritis.  

It’s also important, when possible, to remove or avoid any risk factors that may cause inflammation. This may include ceasing use of NSAIDs or reducing or abstaining from alcohol and tobacco.