Gastritis: symptoms, causes, treatment and diet

The NHS lists the symptoms of gastritis as the following. Guts UK says the symptoms can vary from one person to the next, some people have no symptoms and are found to have it on investigation for other symptoms, and the pain is often described as burning or gnawing.

Guts UK says very rarely, severe gastritis can cause bleeding, which may make the poo turn black (melaena).

• Tummy pain.

• Indigestion.

• Feeling full and bloated.

• Feeling sick (nausea).

• Being sick (vomiting).

• Not feeling as hungry as usual.

The NHS says most symptoms of gastritis are not serious, but sometimes you may need medical help.

Call 999 or go to A&E if you are vomiting bright red blood or your vomit looks like ground coffee, your poo is black, sticky and extremely smelly, or you have severe tummy or chest pain that started suddenly. The NHS says not to drive yourself to A&E.

Ask for an urgent GP appointment or get help from NHS 111 if you have symptoms of gastritis and you have lost your appetite, feel full after a very small meal, have recently lost weight without trying to, feel like there is a lump in your tummy, have painful or difficult swallowing, or keep being sick. The NHS says these can be serious so need to be checked quickly.

The NHS says treatment for gastritis depends on what is causing it. It says if gastritis is not treated it may get worse and cause a stomach ulcer, and that if it is not getting better or causing severe symptoms a GP might refer you to a gastroenterologist, who may do a gastroscopy to look inside your stomach.

Guts UK says most people recover from gastritis with treatment, but others continue to experience symptoms and inflammation, which is called chronic gastritis. If medicines such as PPIs are needed longer term you may be monitored by your GP.

Guts UK says altering your diet does not generally treat the inflammation, but reducing spicy foods, caffeine, fizzy drinks and fried foods might reduce indigestion symptoms while your medical treatment is working. It says eating smaller meals more frequently can prevent weight loss and might be better tolerated.

The NHS lists things to do and things to avoid to ease symptoms.

• Reduce drinks that contain caffeine, such as tea, coffee, cola and energy drinks.

• Lose weight if you are overweight.

• Talk to your doctor if you regularly take anti-inflammatory painkillers such as ibuprofen, or aspirin.

• Do not eat 3 to 4 hours before going to bed.

• Do not have food or drink that is acidic (such as orange juice), fizzy, spicy or fatty.

• Do not drink alcohol and do not smoke.

• A pharmacist can recommend antacids, alginates and acid-reducing medicines for mild indigestion.

The NHS lists the causes below. Guts UK explains that normally the mucus lining protects the stomach from digestive juices such as acid and bile, and gastritis occurs when this protection is weakened.

• Infection with a bacteria called Helicobacter pylori (H. pylori). Guts UK says it is the most common cause of gastritis worldwide.

• Taking anti-inflammatory painkillers such as ibuprofen, and aspirin.

• Drinking too much alcohol.

• Being very stressed and unwell. Guts UK says this can happen in people who are very unwell, for example in intensive care.

• Having surgery on your stomach, such as gastric bypass surgery.

• A problem with your immune system where it attacks the lining of your stomach (autoimmune gastritis).

The NHS says that to find out what is causing symptoms, your doctor might arrange a breath test to check for H. pylori (you are given a special drink and your breath is checked afterwards), a test on a sample of poo, or a blood test.

Guts UK says gastritis is a pathological diagnosis, made by examining a small piece of the stomach lining (a biopsy) under a microscope, and that looking at the lining through an endoscope can raise the suspicion of it. An endoscopy is usually done as an outpatient and takes less than 15 minutes, and you can choose a local anaesthetic throat spray and/or sedative. Guts UK also says a barium swallow and X-ray may be offered if you cannot have an endoscopy, but it is less sensitive.

It depends on the cause. Guts UK says gastritis can be acute (recent onset) or chronic (long-term), and that most people recover with treatment while others have continuing inflammation. The NHS says to see a GP if tummy pain or indigestion lasts longer than 1 week, or gets worse or keeps coming back.

Guts UK says that if indigestion lasts longer than three weeks, and changing lifestyle factors has not worked, symptoms are severe, or you have noticed blood in your poo or vomit, you should see your GP, and should not continue to treat indigestion with over-the-counter medicines without talking to your doctor.

Gastritis itself is inflammation of the stomach lining. Most of the causes the NHS lists, such as anti-inflammatory painkillers, alcohol, stress and an immune system problem, are not infections. One cause, H. pylori, is a bacterial infection. The NHS and Guts UK pages do not describe how H. pylori spreads between people, so ask a GP if you are concerned, particularly if H. pylori has been confirmed.

The NHS and Guts UK pages do not give separate advice for children or pregnancy. In general, tummy pain, vomiting or indigestion lasting longer than a week, or getting worse, should be checked by a GP. If you are pregnant, tell your GP, pharmacist or midwife before taking any indigestion or acid-reducing medicine, so it can be checked for suitability.

If a child has severe tummy pain, repeated vomiting or blood in their vomit, get urgent medical help through NHS 111, a GP or A&E.

The NHS says untreated gastritis may get worse and cause a stomach ulcer. Guts UK says people with autoimmune atrophic gastritis or a long-term H. pylori infection can have a small risk of developing stomach cancer in the future, and that people with autoimmune atrophic gastritis also have a risk of a type of tumour called a carcinoid or neuroendocrine tumour. It stresses that most people will not develop cancer.

Guts UK advises contacting your GP if you have symptoms such as being sick, difficulty swallowing, weight loss, pain, blood in your poo, reflux or indigestion.

On the NHS, gastritis is usually assessed by a pharmacist or GP, who may test for H. pylori and treat the cause, with referral to a gastroenterologist for a gastroscopy if it is severe or not improving. The NHS says a pharmacist can help with mild indigestion.

Some people choose a private gastroenterology appointment or gastroscopy for quicker access. A biopsy and H. pylori testing are standard parts of the work-up, so ask what will be tested and who will manage any treatment, and keep your GP informed.