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Diseases & Conditions  

Gastritis, Chronic - Chronic gastritis, by definition, is a histopathological entity characterized by chronic inflammation of the stomach mucosa. Gastritis's can be classified based on the underlying etiologic agent (eg, Helicobacter pylori, bile reflux, nonsteroidal anti-inflammatory drugs [NSAIDs], autoimmunity, allergic response) and the histopathological pattern, which may suggest the etiologic agent and clinical course (eg, H pylori; associated multifocal atrophic gastritis). Other classifications are based on the endoscopic appearance of the gastric mucosa (eg, varioliform gastritis).


Your stomach — a hollow, muscular sac — sits in the upper-left corner of your abdomen, just under your rib cage. The typical adult stomach is about 10 inches long and can expand to hold about 1 gallon of food and liquid. When your stomach is empty, its tissues fold in on themselves, a bit like a closed accordion. As your stomach fills and expands, the folds gradually disappear.

The two main jobs of your stomach are to help process food and to store food, gradually releasing it into your small intestine. When food arrives from your esophagus, a muscular ring at the joining of your esophagus and stomach (lower esophageal sphincter) relaxes to let it in. Your stomach walls, which are lined with layers of powerful muscles, then begin churning the food, mixing it into smaller and smaller pieces. At the same time, glands in the wall of your stomach pump out gastric juices — including enzymes and stomach acid. These juices help break down food further.

Hydrochloric acid is one of many gastric juices your stomach produces. This helpful but corrosive acid could dissolve your stomach itself if it weren't for the protective sticky mucus lining your stomach walls.

Gastritis occurs when the normal protective mechanisms in your stomach are overwhelmed and damage occurs to your stomach lining. The lining of your stomach then becomes inflamed.

Common causes of gastritis include:

  • Bacterial infection. Gastritis may be caused by a common bacterium called Helicobacter pylori (H. pylori) — the same bug that's to blame for most stomach ulcers. H. pylori lives and multiplies within the mucous layer that covers and protects the lining of your stomach. Often, H. pylori causes no problems. But sometimes, under certain conditions, it can damage the mucous layer and result in inflammation of your stomach lining — gastritis. If bacteria actually erode the tissue of your stomach lining, an ulcer develops. H. pylori may be the most common gastrointestinal infection in the world. Eighty percent of people in developing countries are infected. Although it's not clear exactly how H. pylori spreads, it appears to be transmitted from person to person by close contact. Most people become infected with H. pylori in childhood, and that infection remains throughout life unless antibiotics cure it.

  • Regular use of pain relievers. Certain medications — namely nonsteroidal anti-inflammatory drugs (NSAIDs) — can inflame the lining of your stomach. NSAIDs come in prescription and over-the-counter forms. Examples of nonprescription NSAIDs include aspirin, ibuprofen (Advil, Motrin, others), naproxen (Aleve) and ketoprofen (Orudis). These commonly used pain relievers reduce a protective substance in your stomach called prostaglandin. Taken infrequently and short-term, NSAIDs usually don't cause many stomach problems, especially if taken with antacids, food or milk. However, regular use or overuse may lead to gastritis, as well as stomach ulcers.

  • Excessive alcohol use. Alcohol can irritate and erode the mucous lining of your stomach. Abusing alcohol can give rise to gastritis.

  • Cocaine use. Cocaine can be damaging to the stomach, leading to stomach bleeding and gastritis.

  • Stress. Severe stress due to major surgery, traumatic injury, burns or severe infections may produce gastritis, along with ulcers and stomach bleeding.

  • Autoimmune disorder. One type of gastritis — atrophic gastritis — can be caused by an underlying autoimmune disorder in which your immune system attacks healthy cells in your stomach lining. This causes the lining of your stomach to gradually thin (atrophy). In turn, your stomach produces less gastric acid. In addition, cells in your stomach that produce a substance called intrinsic factor, which helps you absorb vitamin B-12, may be affected by your immune system. An inability to absorb vitamin B-12 leads to a condition known as pernicious anemia. Severe atrophic gastritis and pernicious anemia often coincide and most commonly occur in older adults. Atrophic gastritis is a chronic form of gastritis and rarely causes any gastrointestinal symptoms.

  • Crohn's disease. This bowel disease causes chronic inflammation of the lining of the digestive tract — infrequently including the stomach (gastritis). Signs and symptoms of Crohn's disease, an often painful and debilitating condition, include abdominal pain and watery diarrhea.

  • Radiation and chemotherapy. Cancer treatments such as chemotherapy and radiation may lead to inflammation of the lining of the stomach, leading to stomach ulcers and gastritis.

  • Bile reflux disease. Bile — a fluid that helps you digest fats — is produced in your liver and stored in your gallbladder. Your gallbladder is a small organ on the right side of your abdomen, just beneath your liver. Bile travels to your small intestine to aid in digestion through thin tubes collectively referred to as your bile duct. Normally, a ring-like sphincter muscle (pyloric valve) prevents the backflow of bile from your small intestine into your stomach. However, if this valve doesn't work properly, bile can back up into your stomach causing inflammation (gastritis).

Other, less common forms of gastritis result from more generalized diseases such as liver or kidney failure.

Risk factors

Risk factors for gastritis include:

  • Regular use of aspirin or other NSAIDs. If you regularly take aspirin to prevent a heart attack or stroke, you're at risk of developing gastritis. The same is true if you regularly take an over-the-counter pain reliever other than acetaminophen (Tylenol, others) for arthritis or another chronic condition. Aspirin and other NSAIDs, such as ibuprofen, taken long-term can irritate the lining of the stomach.

  • Alcohol abuse. Anyone who abuses alcohol likely has experienced the discomfort of gastritis and is at risk of more serious health problems, as well.

  • Older age. Adults age 60 and older are at increased risk of gastritis because the lining of the stomach thins with age or as a result of a chronic, underlying condition, such as that due to an autoimmune disorder or H. pylori infection.

Gastritis > 1 > 2 > 3 > 4

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