Gastritis

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 11 Apr 2025

Last updated: 21 Feb 2025

Gastritis is the histological presence of gastric mucosal inflammation. Helicobacter pylori infection and use of non-steroidal anti-inflammatory drugs (NSAIDs) or alcohol are the most common causes. Other causes include stress (secondary to mucosal ischaemia) and autoimmune gastritis. Rare forms include phlegmonous gastritis (a rare bacterial infection).

Diagnosis is based on clinical history and characteristic histological findings. A variety of methods may be used to diagnose H pylori infection.

Presence of suspicious features suggestive of upper gastrointestinal (GI) malignancy requires urgent endoscopy under appropriate clinical conditions. These include GI bleeding, anaemia, early satiety, unexplained weight loss (>10% body weight), progressive dysphagia, odynophagia, or persistent vomiting.

Treatment depends on the aetiology. Options include H pylori-eradication therapy, reduction of NSAIDs or alcohol exposure, and symptomatic therapy with H₂ antagonists and/or proton-pump inhibitors.

If untreated, progression to peptic ulcer disease may occur. Other complications of some forms of gastritis include gastric carcinoma and gastric lymphoma.

Definition

Gastritis is defined as the histological presence of gastric mucosal inflammation. The broader term gastropathy encompasses lesions characterised by minimal or no inflammation.[1][2][3]

Helicobacter pylori infection may cause both an acute and chronic gastritis.[4] Erosive gastritis may occur in response to non-steroidal anti-inflammatory drugs (NSAIDs), alcohol use or misuse, and to bile reflux into the stomach that may follow previous gastric surgery or cholecystectomy.[1][2][3][5][6][7][8] Stress gastritis, most commonly related to mucosal ischaemia seen in critically ill patients, represents a continuum of disease ranging from superficial (erosions) to deep mucosal damage known as stress ulceration.[9] Autoimmune gastritis is a diffuse form of mucosal atrophy characterised by auto-antibodies to parietal cells and intrinsic factor resulting in inflammatory infiltration and atrophy of the corpus mucosa.[3][10] Phlegmonous gastritis is a rare but life-threatening infection of the gastric submucosa and muscularis propria seen in immunocompromised patients.[11][12][13][14]

History and exam

Key diagnostic factors

presence of risk factors
dyspepsia/epigastric discomfort
no suspicious features of malignancy

Full details

Other diagnostic factors

nausea, vomiting, and loss of appetite
severe emesis
acute abdominal pain
fever
altered reflexes or sensory deficits
cognitive impairment
glossitis
co-existing autoimmune disease

Full details

Risk factors

Helicobacter pylori infection
non-steroidal anti-inflammatory drug (NSAID) use
alcohol use/toxic ingestions
previous gastric surgery
critically ill patients
autoimmune disease
immunocompromise
North European or Scandinavian ancestry

Full details

Diagnostic investigations

1st investigations to order

Helicobacter pylori urea breath test
H pylori faecal antigen test
FBC

Full details

Investigations to consider

endoscopy
H pylori rapid urease test
gastric mucosal histology
serum vitamin B12
upper GI contrast series
blood/fluid cultures
parietal cell antibodies
intrinsic factor antibodies

Full details

Emerging tests

H pylori culture/polymerase chain reaction (PCR)

Treatment algorithm

INITIAL

at risk of stress gastritis

ACUTE

Helicobacter pylori associated

erosive

autoimmune

bile reflux

phlegmonous gastritis

Contributors

Authors

Eli D. Ehrenpreis, MD, FACG, AGAF

Professor of Medicine

Rosalind Franklin University Medical School

North Chicago, Illinois

Adjunct Professor of Pediatric Gastroenterology

University of Miami Miller Medical School

Miami, Florida

Associate Director for Research

Internal Medicine Residency

Advocate Lutheran General Hospital

Park Ridge, Illinois

Disclosures

EDE declares that he has no competing interests.

Acknowledgements

Dr Eli D. Ehrenpreis would like to gratefully acknowledge Dr Nicole Marie Gentile, Dr Parakkal Deepak, and Dr Elad Eichenwald, previous contributors to this topic.

Disclosures

NMG, PD, and EE declare that they have no competing interests.

Peer reviewers

Anthony Axon, MB, BS, MD, FRCP

Professor and Consultant Gastroenterologist

Department of Gastroenterology

Leeds General Infirmary

Leeds

Disclosures

AA is the author of studies referenced in this topic.

Garth Swanson, MD

Assistant Professor of Medicine

Section of Gastroenterology and Nutrition

Rush University Medical Center

Chicago

Disclosures

GS declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Varis K. Gastritis - a misused term in clinical gastroenterology. Scand J Gastroenterol Suppl. 1988 Jul 8;155:53-60. Abstract

Glickman JN, Antonioli DA. Gastritis. Gastrointest Endosc Clin N Am. 2001 Oct;11(4):717-40. Abstract

Chey WD, Leontiadis GI, Howden CW, Moss SF. ACG clinical guideline: treatment of helicobacter pylori Infection. Am J Gastroenterol. 2017 Feb;112(2):212-39.Full text Abstract

Lanza FL. A guideline for the treatment and prevention of NSAID-induced ulcers. Members of the Ad Hoc Committee on Practice Parameters of the American College of Gastroenterology. Am J Gastroenterol. 1998 Nov;93(11):2037-46.Full text Abstract

Kavitt RT, Cifu AS. Management of Helicobacter pylori infection. JAMA. 2017 Apr 18;317(15):1572-73. Abstract

Nyssen OP, McNicholl AG, Megraud F, et al. Sequential versus standard triple first-line therapy for Helicobacter pylori eradication. Cochrane Database Syst Rev. 2016 Jun 28;(6):CD009034.Full text Abstract

Ren Q, Yan X, Zhou Y, et al. Periodontal therapy as adjunctive treatment for gastric Helicobacter pylori infection. Cochrane Database Syst Rev. 2016 Feb 7;2:CD009477.Full text Abstract

Lee YC, Chiang TH, Chou CK, et al. Association between Helicobacter pylori eradication and gastric cancer incidence: a systematic review and meta-analysis. Gastroenterology. 2016 May;150(5):1113-1124.e5.Full text Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Peptic ulcer disease (PUD)
- Gastro-oesophageal reflux disease (GORD)
- Non-ulcer dyspepsia
More Differentials
Guidelines
- Informed consent for GI endoscopic procedures
- Adverse events associated with EGD and EGD-related techniques
More Guidelines
Patient information
Peptic ulcers
More Patient information
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Gastritis

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Emerging tests

Treatment algorithm

at risk of stress gastritis

Helicobacter pylori associated

erosive

autoimmune

bile reflux

phlegmonous gastritis

Contributors

Authors

Eli D. Ehrenpreis, MD, FACG, AGAF

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Anthony Axon, MB, BS, MD, FRCP

Disclosures

Garth Swanson, MD

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Patient information

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice