Last updated: February 1, 2022

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Gastritis is an inflammatory process of the gastric mucosa that can be caused by a variety of conditions, commonly H. pylori infection or the use of drugs such as NSAIDs. Patients typically present with dyspepsia and can often be managed with a test-and-treat strategy for H. pylori if there are no indications for an upper endoscopy. Depending on the results, patients receive eradication therapy or a trial of pharmacological acid suppression. Upper endoscopy and biopsy, which can identify histopathological signs of inflammation, are required for definitive diagnosis. Upper endoscopy is indicated in patients over 60 years of age and considered on a case-by-case basis when red flags for dyspepsia are present. Often, gastritis is diagnosed incidentally, when upper endoscopy is performed for other reasons. The underlying cause of gastritis may be obvious (e.g., direct injury from medication intake), but further testing may be required in order to identify the etiology and provide the optimal treatment.

  • Gastritis: inflammation of the gastric mucosa, typically in response to H. pylori infection (H. pylori gastritis), direct injury (e.g., substance-induced gastritis), or as part of a systemic inflammatory disease [1]
  • Gastropathy: injury to the gastric mucosa, usually involving a disruption in the protective mucous barrier. In contrast to gastritis, gastropathy is accompanied by little to no inflammation.
Etiology of gastritis [2]
Mechanism Cause
External Infectious
Patient-related Systemic diseases

Helicobacter pylori infection is the most common cause of gastritis.

There are multiple classification systems for gastritis. There is significant overlap between different types, e.g., in the histopathological findings of acute and chronic gastritis. The most common types are described here. [1][2]

The differential diagnoses listed here are not exhaustive.

Approach [4]

Although gastritis is diagnosed based on the results of gastric mucosal biopsy, not all patients require invasive diagnostic testing. For more detailed recommendations, see “Approach to dyspepsia.”

Esophagogastroduodenoscopy (EGD) with biopsies [1][4]

  • Endoscopic findings
  • Histopathologic findings: dependent on etiology

Patients with upper GI symptoms are often treated empirically (see “Approach to dyspepsia”). If gastritis is confirmed by upper endoscopy, treatment should be tailored to the underlying etiology. [4]

Atrophic gastritis

Atrophic gastritis is a type of chronic gastritis. See “Atrophic gastritis for details on its clinical features, diagnostics, and treatment.

Chemical gastritis [1][8]

Ménétrier disease [9][10]

Specific infiltrates

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  10. Nils W. G. Lambrecht. Ménétrier’s Disease of the Stomach: A Clinical Challenge. Curr Gastroenterol Rep. 2011; 13 (6): p.513-517. doi: 10.1007/s11894-011-0222-8 . | Open in Read by QxMD
  11. Hauser SC, Pardi DS, Poterucha JJ. Mayo Clinic Gastroenterology and Hepatology Board Review. CRC Press ; 2005
  12. Chey WD, Leontiadis GI, Howden CW, Moss SF. ACG Clinical Guideline: Treatment of Helicobacter pylori Infection. Am J Gastroenterol. 2017; 112 : p.212-238. doi: 10.1038/ajg.2016.563 . | Open in Read by QxMD
  13. Ahmed Madisch, Viola Andresen, Paul Enck, Joachim Labenz, Thomas Frieling, Michael Schemann. The Diagnosis and Treatment of Functional Dyspepsia. Deutsches Aerzteblatt Online. 2018 . doi: 10.3238/arztebl.2018.0222 . | Open in Read by QxMD
  14. Lymphocytic gastritis. Updated: December 11, 2019. Accessed: March 19, 2020.
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