Gastritis is the medical term for inflammation of the stomach lining, which can cause symptoms ranging from mild discomfort to severe, burning pain in the upper abdomen. While many cases of stomach irritation are temporary, gastritis can last for months or even years if the underlying cause remains unaddressed. When inflammation persists long-term, it is classified as chronic gastritis, a condition requiring specific medical intervention.
Acute Versus Chronic Gastritis Timelines
The duration of inflammation differentiates the two main types of gastritis. Acute gastritis is characterized by a rapid onset of symptoms and is typically a short-lived event. Most cases of acute inflammation resolve entirely within a period of a few days to a couple of weeks, especially once the triggering factor is removed.
In contrast, chronic gastritis involves inflammation that develops slowly and persists for a significantly longer duration, often stretching into months or years if the irritant is never eliminated. Sustained inflammation causes progressive changes to the gastric mucosa. Over time, the presence of inflammatory cells can lead to structural alterations in the stomach lining, increasing the need for a precise diagnosis to identify the root cause preventing recovery.
Primary Causes of Persistent Gastritis
Chronic gastritis almost always traces back to one of three main ongoing drivers of mucosal damage. The most common cause worldwide is a bacterial infection with Helicobacter pylori, a spiral-shaped microorganism that colonizes the stomach lining. This bacterium generates a continuous inflammatory response that can persist for decades, slowly damaging the protective layer of the stomach.
A second major cause involves the prolonged use of Nonsteroidal Anti-inflammatory Drugs (NSAIDs) like ibuprofen or naproxen. These drugs inhibit enzymes responsible for producing protective prostaglandins in the stomach. Regular NSAID use suppresses these protective chemicals, leaving the stomach lining vulnerable to damage from digestive acids.
Autoimmune gastritis represents a third cause where the body’s immune system mistakenly targets the stomach’s parietal cells. These cells produce stomach acid and intrinsic factor, which is needed to absorb Vitamin B12. The resulting chronic inflammation leads to the gradual destruction of these cells, causing atrophic gastritis. This autoimmune response creates a permanent source of inflammation requiring ongoing management.
Confirming Chronic Gastritis Through Diagnosis
Confirming chronic gastritis and identifying the specific cause requires a multi-step diagnostic process. The most definitive diagnostic step is an upper endoscopy, where a thin, flexible tube equipped with a light and camera is passed into the stomach. During this examination, a medical professional can visually inspect the gastric mucosa for signs of long-term inflammation, such as redness, thinning, or nodularity.
The endoscopy is made definitive by the concurrent performance of a biopsy, where tiny tissue samples are taken from the stomach lining. Histologic analysis confirms chronic inflammation by identifying the specific types of inflammatory cells present. Biopsy also allows for direct assessment of the severity of the condition and detection of precancerous changes that can sometimes occur after years of chronic irritation.
If H. pylori is suspected, several non-invasive tests can be used before or after endoscopy. These include the urea breath test, which detects the bacteria through a chemical reaction in the breath, and the stool antigen test, which looks for bacterial proteins. Blood tests can also check for antibodies against the bacterium or look for nutrient deficiencies, such as low Vitamin B12, associated with autoimmune gastritis.
Treatment Approaches for Long-Term Gastritis
Effective treatment for long-term gastritis depends entirely on resolving the specific chronic cause identified during diagnosis. For cases driven by H. pylori infection, the primary approach is eradication therapy. This involves a combination of two different antibiotics and a proton pump inhibitor (PPI). This combination therapy is typically taken for ten to fourteen days and aims to eliminate the bacteria and suppress stomach acid production to allow the inflamed tissue to heal.
When NSAIDs are the confirmed culprit, the treatment focuses on either stopping the use of the drug or switching to a less irritating pain management option. If NSAID use is medically necessary, a doctor will prescribe a long-term acid-suppressing medication, such as a PPI, to be taken concurrently. This protective strategy creates a barrier against the ongoing chemical irritation.
For individuals with autoimmune gastritis, the treatment strategy shifts away from eradication. Management focuses on addressing the consequences, primarily the Vitamin B12 deficiency that results from the loss of intrinsic factor. This is managed with regular Vitamin B12 injections or high-dose oral supplementation to prevent the development of pernicious anemia. General management strategies across all forms of chronic gastritis include dietary modifications to avoid mucosal irritants like alcohol, spicy foods, and caffeine. Acid suppressants are also used to reduce the overall level of irritation and promote healing.