Gastritis is inflammation of the stomach lining, most often caused by Helicobacter pylori infection, NSAIDs or heavy alcohol use. Many cases are mild, but erosive gastritis can bleed, and long-standing H. pylori raises the risk of ulcers and stomach cancer.
Key symptoms
- Burning or gnawing pain in the upper middle belly
- Nausea, sometimes with vomiting
- Feeling full quickly or bloated after meals
- Loss of appetite
- Often no symptoms at all
What you find on exam
- Mild tenderness in the epigastrium without guarding
- Vital signs; look for a fast pulse or low pressure from bleeding
- Pale skin or conjunctiva suggesting anemia
- Rectal exam for dark, tarry stool when bleeding is suspected
Tests
- H. pylori test: urea breath test or stool antigen
- Blood count for anemia from slow bleeding
- Upper endoscopy with biopsy for age 60 or older, alarm features or no response to treatment
- Lipase and liver tests when the pain pattern is unclear
Treatment basics
- Stop NSAIDs and limit alcohol and smoking
- Proton pump inhibitor such as omeprazole
- Treat H. pylori with bismuth quadruple therapy (PPI, bismuth, tetracycline, metronidazole) for 14 days
- Confirm H. pylori cure with a breath or stool test at least 4 weeks after antibiotics
Red flags
- Vomiting blood or material that looks like coffee grounds
- Black, tarry stools or dizziness on standing
- Weight loss, trouble swallowing or persistent vomiting
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.