Gastritis is an inflammation of the lining of the stomach. There are many possible causes of this disorder, including an infection, an irritant, an autoimmune disorder, or a backup of bile into the stomach. The stomach lining may be "eaten away," leading to sores (peptic ulcers) in the stomach or first part of the small intestine. Left untreated, these ulcers may bleed. Gastritis can occur suddenly (acute gastritis) or gradually (chronic gastritis). In most cases, gastritis does not permanently damage the stomach lining, and sometimes no specific cause of the inflammation is identified.

The most common symptoms of gastritis are stomach upset and pain. Other possible symptoms include:

• Indigestion (also called dyspepsia)
• Heartburn
• Abdominal pain
• Hiccups
• Loss of appetite
• Nausea
• Vomiting, possibly of blood (called hematemesis) or material that looks like coffee-grounds
• Dark stools

Gastritis can be caused by infection, irritation, autoimmune disorders (disorders caused by the body's immune response against its own tissues), or backflow of bile into the stomach (bile reflux). Gastritis can also be caused by a blood disorder called pernicious anemia.

Infections can be any of the following types:

• Bacterial (usually Helicobacter pylori)
• Viral (including herpes simplex virus)
• Parasitic
• Fungal

A number of things can cause irritation, including:

• Long-term medication use, such as , aspirin, ibuprofen or other non-steroidal anti-inflammatory drugs (NSAIDS)
• Alcohol use
• Cigarette smoking
• Chronic vomiting
• Coffee and acidic beverages
• Excess gastric acid secretion (such as from stress)
• Eating or drinking caustic or corrosive substances (such as poisons)
• Trauma (for example, radiation treatments or having swallowed a foreign object)

Other causes for gastritis are very rare. These include:

• Systemic disease (for example, Crohn's disease)
• Sarcoidosis

• Infection with H. pylori 
• Crowded, unsanitary conditions -- this may increase risk of contracting H. pylori 
• Acquired immunodeficiency syndrome (AIDS)
• Any condition that requires relief from persistent pain using NSAIDS, such as chronic low back pain, fibromyalgia, or arthritis
• Alcoholism
• Cigarette smoking
• Older age
• Genetic abnormalities

Several tests can be used to make a diagnosis. These include endoscopy of the stomach, where a thin tube with a light and a camera on the end is inserted down your throat to your stomach. This allows the doctor to see into your stomach and, if necessary, take samples (called a biopsy) from the lining. The laboratory tests you may need will depend on the specific cause of your gastritis. A stool test may be used to check for the presence of blood, or a biopsy may be taken of the tissues of your esophagus or stomach to determine the cause of your discomfort. A breath test may detect H. pylori, or samples from your esophagus or stomach may be taken to look for this organism.

Making lifestyle changes, such as avoiding the long-term use of irritants (aspirin, anti-inflammatory drugs, coffee, and alcohol), will help in preventing gastritis and its complications (such as a peptic ulcer). Stress reduction through relaxation techniques -- including yoga, tai chi, and meditation -- can also be helpful.

Treatment of gastritis depends on the cause of the problem. Some causes may resolve by themselves over time, or may be relieved by stopping the ingestion of irritating substances, such as alcohol, tobacco, and aspirin. Some dietary changes will no doubt be recommended, although the bland diet often prescribed in the past is no longer thought to be necessary. Medications are often necessary to relieve symptoms, eradicate an infection such as H. pylori, and prevent or treat complications from gastritis, such as an ulcer.

Lifestyle

The cure for gastritis caused by ingesting irritating substances is to stop the long-term use of these substances, which may include:

• Alcohol.
• Tobacco.
• Acidic beverages such as coffee (both caffeinated and decaffeinated), carbonated beverages, and fruit juices with citric acid.
• NSAIDS, such as aspirin and ibuprofen -- switch to other pain relievers (like acetominophen)
• Eat a fiber-rich diet.
• Foods containing flavonoids, like apples, celery, cranberries (including cranberry juice), onions, garlic, and tea may inhibit the growth of H. pylori.
• Avoid high fat foods (at least from animal studies, high fat foods increase inflammation in the stomach lining).

Medications

If you have H. pylori, you will probably be prescribed three different medications. "Triple therapy" (including a proton pump inhibitor, such as omeprazole or Prilosec, to reduce acid production and two antibiotics to get rid of the organism) is commonly used to treat H. pylori-related gastritis and ulcers. Instead of one of the antibiotics, bismuth salicylate may be the third medication recommended. This drug, available over the counter, coats and soothes the stomach, protecting it from the damaging effects of acid. Two-drug regimens are currently being developed.

Some of the same drugs are used for non-H. pylori gastritis as well as for symptoms (like indigestion) due to ulcers of any cause:

• Antacids, available over the counter, may relieve heartburn or indigestion but will not treat an ulcer. Antacids include aluminum hydroxide (Amphojel, AlternaGEL), magnesium hydroxide (Phillips' Milk of Magnesia), aluminum hydroxide and magnesium hydroxide (Maalox, Mylanta), calcium carbonate (Rolaids, Titralac, Tums), and sodium bicarbonate (Alka-Seltzer). Antacids may block medications from being absorbed and thereby decrease the medicine's effectiveness. It is recommended to take antacids at least 1 hour before or 2 hours after taking medications. Ask your pharmacist or doctor for more information.
• H2 blockers, such as cimetidine (Tagemet), ranitidine (Zantac), nizatidine (Axid), and famotidine (Pepcid), reduce gastric acid secretion.
• Proton-pump inhibitors, including esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), and rabeprazole (Aciphex), decrease gastric acid production.
• Sucralfate (Carafate) makes a coating over the ulcer crater, protecting it from further damage.

Nutrition and Dietary Supplements

Doctors used to recommend eating bland foods with milk and only small amounts of food with each meal. It is now know that these eating habits are not necessary for the treatment of gastritis and ulcers. Following these nutritional tips may help reduce symptoms:

• Foods containing flavonoids, like apples, celery, cranberries (including cranberry juice), onions, garlic, and tea may inhibit the growth of H. pylori.
• Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell peppers).
• Eat foods high in B-vitamins and calcium, such as almonds, beans, whole grains (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables.
• Avoid refined foods, such as white breads, pastas, and especially sugar.
• Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy) or beans for protein.
• Use healthy oils, such as olive oil or vegetable oil.
• Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid beverages that can irritate the lining of the stomach or increase acid production including coffee (with or without caffeine), alcohol, and carbonated beverages.
• Drink 6 - 8 glasses of filtered water daily.
• Exercise at least 30 minutes daily, 5 days a week.

Nutritional deficiencies may be addressed with the following supplements:

• A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium.
• Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tablespoonful oil 2 - 3 times daily, to help decrease inflammation and improve immunity. Cold-water fish, such as salmon or halibut, are good sources, but supplementation is recommended.
• Probiotic supplement (containing Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. Some probiotic supplements may need to be refrigerated for best results. Your child may also take probiotic supplements. Consult with your health care provider before giving your child any dietary supplements.
• Alpha-lipoic acid, 25 - 50 mg twice daily, for antioxidant support.
• Vitamin C, 500 - 1,000 mg 1 - 3 times daily, as an antioxidant and for immune support.
• L-glutamine, 500 - 1,000 mg 3 times daily, for support of gastrointestinal health and immunity.
• Grapefruit seed extract (Citrus paradisi), 100 mg capsule or 5 - 10 drops (in favorite beverage) 3 times daily when needed, for antibacterial, antifungal, and antiviral activity, and for immunity.
• Resveratrol (from red wine), 50 - 200 mg daily, to help decrease inflammation and for antioxidant effects.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

• Green tea (Camellia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant, anti-inflammatory, and heart health effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.
• Cat's claw (Uncaria tomentosa) standardized extract, 20 mg 3 times a day, for inflammation and antibacterial, or antifungal activity.
• Reishi mushroom (Ganoderma lucidum), 150 - 300 mg 2 - 3 times daily, for inflammation and for immunity. You may also take a tincture of this mushroom extract, 30 - 60 drops two 2 - 3 times a day.
• Olive leaf (Olea europaea) standardized extract, 250 - 500 mg 1 - 3 times daily, for antibacterial or antifungal activity and immunity. You may also prepare teas from the leaf of this herb.
• DGL-licorice (Glycyrrhiza glabra) standardized extract, 250 - 500 mg 3 times daily, chewed either 1 hour before or 2 hours after meals. Glycyrrhizin is a chemical found in licorice that causes side effects and drug interactions. DGL is deglycyrrhizinated licorice, or licorice with the glycyrrhizin removed.
• Mastic (Pistacia lentiscus) standardized extract, 1,000 - 2,000 mg daily in divided dosages, for activity against H. Pylori.
• Peppermint (Mentha piperita) standardized, enteric coated tablet, 1 tablet 2 - 3 times daily, for symptoms of peptic ulcer. Each tablet contains 0.2 ml peppermint oil.
• Tumeric (Curcuma longa) standardized extract, 300 mg 3 times a day, for pain and inflammation.

Homeopathy

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of gastritis symptoms (such as nausea and vomiting) based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account your constitution -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for you individually.

• Pulsatilla -- for heartburn, queasiness, a bad taste in the mouth brought on by eating rich foods and fats (especially ice cream); symptoms may include vomiting partly digested food. This remedy is most appropriate for an individual whose tongue is coated with a white or yellow substance.
• Ipecacuahna -- for persistent and severe nausea, with or without vomiting and diarrhea, caused by an excess of rich or fatty foods.
• Carbo vegetabilis -- for bloating and indigestion, especially with flatulence and fatigue.
• Nux vomica -- for heartburn, nausea, retching without vomiting, and sour burps caused by overeating, alcohol use, or coffee drinking. This remedy is most appropriate for individuals who also feel irritable and sensitive to noise and light.

Acupuncture

Acupuncture may help reduce stress and improve overall digestive function.

Return to your health care provider if your symptoms do not get better or get worse. Do not ignore potentially life-threatening symptoms, such as vomiting blood or blood in your stool. Be aware that you may not see frank blood in your stool. The stools may simply look very dark, even black. Be sure to see your health care provider regularly, and call your doctor if there is any change in your symptoms.

If you are on both antibiotics and vitamin B12, take them at different times of day because vitamin B12 interferes with antibiotic absorption.

Pregnancy

If you are pregnant or breastfeeding, you should consult with your doctor before taking any medication, including herbs.

Prognosis and Complications

Symptoms of H. pylori infection are usually relieved with treatment, but you will most likely be asked to see your doctor 4 weeks or more after stopping your drug regimen. Follow-up is very important, because the H. pylori bacteria are linked to stomach cancer.

Peptic ulcers may develop when digestive juices damage the lining of the stomach or the first part of the small intestine (called the duodenum). These ulcers can generally be treated effectively with lifestyle changes and medication.

Aly AM, Al-Alousi L, Salem HA. Licorice: a possible anti-inflammatory and anti-ulcer drug. AAPS PharmSciTech. 2005;6(1):E74-82.

Bujanda L. The effects of alcohol consumption upon the gastrointestinal tract. Am J Gastroenterol. 2000;95(12):3374-3382.

Burger O, Ofek I, Tabak M, Weiss EI, Sharon N, Neeman I. A high molecular mass constituent of cranberry juice inhibits helicobacter pylori adhesion to human gastric mucus. FEMS Immunol Med Microbiol. 2000 Dec;29(4):295-301.

Burger O, Weiss E, Sharon N, Tabak M, Neeman I, Ofek I. Inhibition of Helicobacter pylori adhesion to human gastric mucus by a high-molecular-weight constituent of cranberry juice. Crit Rev Food Sci Nutr. 2002;42(3 Suppl):279-284.

Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea--a review. J Am Coll Nutr. 2006;25(2):79-99.

Cremonini F, Di Caro S, Covino M, et al. Effect of different probiotic preparations on anti-helicobacter pylori therapy-related side effects: a parallel group, triple blind, placebo-controlled study. Am J Gastroenterol. 2002;97(11):2744-2749.

El-Serag HB, Satia JA, Rabeneck L. Dietary intake and the risk of gastro-oesophageal reflux disease: a cross sectional study in volunteers. Gut. 2005;54(1):11-7.

Fox M, Barr C, Nolan S, Lomer M, Anggiansah A, Wong T. The effects of dietary fat and calorie density on esophageal acid exposure and reflux symptoms. Clin Gastroenterol Hepatol. 2007;5(4):439-44.

Gorbach SL. Probiotics in the third millennium. Dig Liver Dis. 2002;34(Suppl 2):S2-S7.

Han KS. The effect of an integrated stress management program on the psychologic and physiologic stress reactions of peptic ulcer in Korea. J Holist Nurs. 2002;20(1):61-80.

Hardin SR. Cat's claw: an Amazonian vine decreases inflammation in osteoarthritis. Complement Ther Clin Pract. 2007;13(1):25-8.

Kaptan K, Beyan C, Ural AU, et al. Helicobacter pylori -- is it a novel causative agent in vitamin B12 deficiency? Arch Intern Med. 2000;160(9):1349-1353.

Khayyal MT , el-Ghazaly MA, Kenawy SA, et al. Antiulcerogenic effect of some gastrointestinally acting plant extracts and their combination. Arzneimittelforschung. 2001;51(7):545-553.

Kim DC, Kim SH, Choi BH, Baek NI, Kim D, Kim MJ, Kim KT. Curcuma longa extract protects against gastric ulcers by blocking H2 histamine receptors. Biol Pharm Bull. 2005;28(12):2220-4.

Klausz G, Tiszai A, Lenart Z, et al., Helicobacter pylori-induced immunological responses in patients with duodenal ulcer and in patients with cardiomyopathies. Acta Microbiol Immunol Hung. 2004;51(3):311-20.

Marteau P, Boutron-Ruault MC. Nutritional advantages of probiotics and prebiotics. Br J Nutr. 2002;87(Suppl 2):S153-S157.

Marteau PR. Probiotics in clinical conditions. Clin Rev Allergy Immunol. 2002;22(3):255-273.

Martin B. Prevention of gastrointestinal complications in the critically ill patient. AACNAdv Crit Care. 2007;18(2):158-66.

McManus TJ. Helicobacter pylori: an emerging infectious disease. Nurs Pract. 2000;25(8):42-46.

Olafsson S, Berstad A. Changes in food tolerance and lifestyle after eradication of Helicobacter pylori. Scand J Gastroenterol. 2003;38(3):268-76.

Paraschos S, Magiatis P, Mitakou S, et al., In vitro and in vivo activities of Chios mastic gum extracts and constituents against Helicobacter pylori. Antimicrob Agents Chemother. 2007;51(2):551-9.

Qasim A, O'Morain CA. Review article: treatment of Helicobacter pylori infection and factors influencing eradication. Aliment Pharmacol Ther. 2002;16(Suppl 1):24-30.

Rosch W, Vinson B, Sassin I. A randomised clinical trial comparing the efficacy of a herbal preparation STW 5 with the prokinetic drug cisapride in patients with dysmotility type of functional dyspepsia. Z Gastroenterol. 2002;40(6):401-408.

Ryan SW. Management of dyspepsia and peptic ulcer disease. Altern Ther Health Med. 2005;11(5):26-9; quiz 30.

Shibata K, Mariyama M, Fukushima T, Kaetsu A, Miyazaki M, Une H. Green tea consumption and chronic atrophic gastritis: a cross-sectional study in a green tea production village. J Epidemiol. 2000;10(5):310-316.

Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr. 2002;21(6):495-505.

Sugimoto N, Yoshida N, Nakamura Y, Ichikawa H, Naito Y, Okanoue T, Yoshikawa T. Influence of vitamin E on gastric mucosal injury induced by Helicobacter pylori infection. Biofactors. 2006;28(1):9-19.

Vonkeman HE, Fernandes RW, van de Laar MA. Under-utilization of gastroprotective drugs in patients with NSAID-related ulcers. Int J Clin Pharmacol Ther. 2007;45(5):281-8.

Woodward M, Tunstall-Pedo H, McColl K. Helicobacter pylori infection reduces systemic availability of dietary vitamin C. Eur J Gastroenterol Hepatol. 2001;13(3):233-237.