What really hurts
Complaints with gastritis are nonspecific, and they cannot distinguish it from ulcers, functional dyspepsia, or diseases of the gallbladder and pancreas.
- Aching or burning pain in the upper abdomen, often associated with eating
- Feeling of fullness and early satiety
- Nausea, belching, heartburn
- Heaviness after eating, bloating
- Decreased appetite
Helicobacter pylori - the main question
This bacterium is the main cause of chronic gastritis, peptic ulcers and an important risk factor for stomach cancer. Its identification and destruction (eradication) changes the prognosis, so testing for it is mandatory.
- Breath urease test - an accurate non-invasive method
- Determination of antigen in feces is also reliable
- Rapid urease test and biopsy histology during gastroscopy
- Antibodies in the blood are not suitable for monitoring cure: they remain positive for years after successful treatment
Before testing, you must stop taking proton pump inhibitors 2 weeks in advance and antibiotics 4 weeks in advance - otherwise the result will be false negative.
When is gastroscopy needed?
- New complaints in a patient over 45 years of age
- Any of the “red flags”: weight loss, anemia, vomiting blood, black stools, difficulty swallowing
- No effect of treatment
- Peptic ulcer or stomach cancer in close relatives
- Need to take a biopsy to evaluate atrophy and intestinal metaplasia
In young patients without warning signs, a “test and treat” strategy is acceptable: first, a non-invasive test for Helicobacter, eradication if the result is positive, and only if ineffective, gastroscopy.
Treatment
- If H. pylori is detected, eradication therapy: a combination of two antibiotics and a proton pump inhibitor for a course of 10–14 days
- The course must be completed in full: an incomplete scheme leads to bacterial resistance
- Control of cure 4–6 weeks after completion of the course with a breath test or stool analysis
- Proton pump inhibitors - for erosions and severe symptoms
- Stop or change NSAIDs if they are the cause
- For atrophic gastritis - control of vitamin B12 and observation with periodic gastroscopy
Nutrition: no extremes
Strict Soviet-style diets for chronic gastritis have no proven effectiveness and often only lead to a poorer diet. Reasonable recommendations are easier.
- Regular meals without long breaks, do not overeat
- Limit what causes symptoms for you - there is no universal list
- Reduce alcohol, strong coffee on an empty stomach, very spicy and fatty foods if tolerated poorly
- Stop smoking - it slows down the healing of the mucous membrane
- Do not take NSAIDs unless necessary; If you take them for a long time, discuss stomach protection with your doctor
- Eat slowly, chewing thoroughly
