Gastritis and Ulcers

Gastritis and Ulcers

This information is intended only to provide general guidance.  It does not provide definitive medical advice.  It is important that you consult your doctor about your specific condition.

What is the stomach and what does it do?

The stomach is the hollow organ where food begins to be digested.  The stomach produces acid and a digestive enzyme called pepsin, which breaks down protein into smaller substances (digestion).  Below the inner lining of the stomach (the mucosa) is a layer of muscle which squeezes and grinds food into thick liquid.  The partially digested food then enters the duodenum, which is the first part of the small intestine, where the digested nutrients from food are absorbed into the bloodstream and the rest of the body.  There is a thick layer of mucus that coats the lining of the stomach and, along with special characteristics of the lining, protects the lining of the stomach from injury from the acidic digestive juice inside the stomach.

What is gastritis?

Gastritis is a disease in which there is inflammation (swelling or irritation) of the inner lining (the mucosa) of the stomach.  Gastritis is described as acute if it starts suddenly and lasts a short time and chronic if it lasts a long time.  Some gastritis is erosive, in which small breaks (erosions) occur in the lining of the stomach.  Gastritis may also be nonerosive, in which there are no gastric erosions.  Sometimes the duodenum, the part of the small intestine just beyond the stomach, is also inflamed; this is called duodenitis.

What are ulcers (peptic ulcers)?

When the gastritis or duodenitis is particularly severe or is left untreated, more extensive injury can develop, resulting in a peptic ulcer, or sore, in the lining of the stomach or duodenum.  Gastric ulcers occur in stomach, and duodenal ulcers in the duodenum, the first part of the small intestine just beyond the stomach.

What causes gastritis and ulcers?

  • H. pylori (Helicobacter pylori), a bacteria that chronically infects the stomach, usually beginning in childhood, remains dormant for many years until it results in ulcers or symptoms of gastritis or duodenitis.  H. pylori is present in 20-30% of Americans and up to 90% of people from developing countries.  Many people with H. pylori do not develop problems because of the infection.
  • Nonsteroidal anti-inflammatory drugs (NSAID's) or aspirin taken frequently for weeks or longer.  Some NSAID’s are ibuprofen, naproxen, diclofenac, and meloxicam (brand names:  Advil, Motrin, Aleve, Voltaren, Mobic).  Alka-Seltzer often contains aspirin and may cause or worsen ulcers.
  • Severe physical stress such as major trauma, critical illnesses, severe burns, and major surgery.
  • Alcohol abuse or cocaine use.
  • Autoimmune gastritis, in which the immune system reacts against normal stomach tissue.
  • Other diseases such as Crohn's disease, sarcoidosis, food allergies, and syphilis.

What are the symptoms of gastritis and peptic ulcers?

  • Upper abdominal pain (burning, gnawing, dull, or gripping), often worse when the stomach is empty: several hours after a meal or at night.
  • Nausea and/or vomiting.
  • Loss of appetite.
  • Fullness or bloating in the upper abdomen.
  • Black stools (melena) due to internal bleeding.

You should see a doctor immediately if there is unexpected weight loss or signs and symptoms of bleeding or severe anemia, such as:

  • Shortness of breath.
  • Black, tarry stools (melena).
  • Passing red blood from the rectum.
  • Dizziness or feeling of fainting.
  • Weakness.
  • Pale skin.

How is gastritis or peptic ulcer diagnosed?

Dr. Albert Harary, in his New York City office, may suspect the diagnosis of gastritis or ulcers by taking a medical history.  The best way to confirm the diagnosis, check for H. pylori bacteria, and exclude other diseases that can cause similar symptoms, is often the diagnostic test called upper GI endoscopy, or esophago-gastro-duodenoscopy (EGD) (see web page on EGD).

The diagnosis of H.  Pylori infection can be made by:

  • taking biopsies during an EGD.
  • A stool test for H. pylori.
  • A urea breath test, in which a liquid containing specially labeled urea, a chemical, is drunk by the patient, after which the patient breathes into a container.  The exhaled air in the container is then sent from Dr. Harary's office to a commercial laboratory for analysis.
  • A blood test for antibodies to the H. pylori bacteria.  This test is less useful because it does not distinguish a past infection from an active, current infection and does not reveal how seriously the H. pylori is affecting the stomach.

What are the complications of gastritis or peptic ulcers?

Most cases of gastritis or peptic ulcers do not result in complications, but they can result in:

  • Hemorrhage (excessive bleeding), usually manifest by passing black stool (melena) or red blood from the rectum, or vomiting either red blood or blackish (coffee grounds) material.
  • Anemia, due to gradual, long-term blood loss resulting in iron deficiency.  This can result in fatigue, weakness, shortness of breath, dizziness, or fainting.
  • Vitamin B12 deficiency, which can lead to anemia or neurologic disease.
  • Atrophic gastritis, in which chronic gastritis leads to loss of the stomach lining and glands that manufacture acid and digestive enzymes.  This may be accompanied by intestinal metaplasia, in which the cells in the stomach begin to resemble the cells of the intestine.
  • Gastric cancer or lymphoma.
  • Obstruction, in which scarring causes narrowing of the junction of the stomach and duodenum, resulting in getting full easily during meals (early satiety), nausea, or vomiting.

How are gastritis and ulcers treated?

Medications to reduce stomach acid:

  • H2 blockers such as ranitidine (Zantac), famotidine (Pepcid), nizatidine (Axid), and cimetidine (Tagamet).  These must be taken at least twice a day for 1-4 weeks or longer.  They are available by prescription or in lower doses over the counter.
  • PPI’s (proton pump inhibitors).  These drugs decrease acid production more effectively than H2 blockers.  They include omeprazole (Prilosec, Zegerid), esomeprazole (Nexium), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), and dexlansoprazole (Dexilant).  If they need to be taken for more than 2 weeks, it should be under the supervision of a doctor.  The over-the-counter forms of these medications are usually not as strong as the prescription forms.
  • Antacids such as Mylanta, Maalox, Gaviscon, TUMS, Rolaids, and Pepcid Complete.  These provide quick relief of symptoms because they neutralize existing acid, but they do not heal the underlying gastritis.

Treat H. pylori if present.  Treatment requires a proton pump inhibitor plus 2-3 antibiotics taken for 7-14 days.  Some treatment programs also include bismuth (Pepto-Bismol).  Dr. Albert Harary, in his New York City office, prescribes the appropriate medications and detailed instructions on how to take them.  No single treatment program will successfully eliminate all H. pylori infections, so repeat testing for H. pylori is needed if the symptoms come back.

Decrease or eliminate NSAID’s or alcohol. Alternatives to NSAID’s include acetaminophen (Tylenol) and celecoxib (Celebrex), which is similar to NSAID’s but less toxic to the stomach.

Avoid spicy, fatty, or fried foods, alcohol, and acidic foods/liquids such as coffee, citrus, tomatoes.

Stop smoking tobacco.

To learn more about gastritis and ulcer treatment and diagnosis offered by Dr. Harary, please contact our New York City office.