Summary

Acute gastritis is sudden inflammation of the stomach lining, usually caused by irritants like medications (especially NSAIDs like ibuprofen or aspirin), alcohol, stress, or infection (H. pylori bacteria). Think of your stomach lining as a protective barrier—when it becomes inflamed, it can't protect itself from stomach acid, leading to pain, nausea, and sometimes bleeding. This condition is very common, affecting millions of people each year, and is usually mild and self-limiting. However, severe cases can cause significant bleeding (upper GI bleeding) or progress to ulcers. The key to management is identifying and removing the cause (stop NSAIDs, reduce alcohol, treat H. pylori if present), using medications to reduce stomach acid (PPIs, H2 blockers), and supportive care. Most cases resolve completely within days to weeks with treatment.

Key Facts

• Definition: Acute inflammation of the gastric mucosa (stomach lining)
• Incidence: Very common (millions of cases/year), often undiagnosed
• Mortality: Very low (<0.1%) unless complications (bleeding)
• Peak age: All ages, but more common in older adults (NSAID use)
• Critical feature: Epigastric pain/discomfort, often related to irritants
• Key investigation: Clinical diagnosis (usually), endoscopy if severe or bleeding
• First-line treatment: Remove cause (stop NSAIDs/alcohol), PPI (omeprazole), treat H. pylori if present

Clinical Pearls

"NSAIDs are the most common cause" — Non-steroidal anti-inflammatory drugs (ibuprofen, naproxen, aspirin) are the most common cause of acute gastritis. Always ask about medication use, including OTC drugs.

"Most gastritis is mild and self-limiting" — Most cases resolve with removing the cause and simple acid-reducing medications. Don't over-investigate mild cases.

"Bleeding suggests severe gastritis or ulcer" — If there's upper GI bleeding (vomiting blood or black stools), this is more serious and needs urgent investigation (endoscopy).

"H. pylori is a common cause" — Helicobacter pylori bacteria can cause gastritis. If present, treating it (antibiotics + PPI) can cure the gastritis and prevent recurrence.

Why This Matters Clinically

Acute gastritis is very common and usually mild, but can cause significant symptoms and sometimes serious complications (bleeding, ulcers). Early recognition and treatment (removing the cause, acid-reducing medications) can prevent complications and provide rapid relief. Most cases resolve completely, but some can become chronic or progress to ulcers if not treated. This is a condition that primary care clinicians see frequently and can manage effectively.

Structured Approach: ABCDE

A - Airway

• Assessment: Usually patent
• Action: Secure if compromised

B - Breathing

• Look: Usually normal
• Listen: Usually normal
• Measure: SpO2 (usually normal)
• Action: Support if needed

C - Circulation

• Look: Usually normal (pale if bleeding)
• Feel: Pulse (usually normal), BP (usually normal, low if bleeding)
• Listen: Heart sounds (usually normal)
• Measure: BP (usually normal), HR
• Action: Monitor if bleeding

D - Disability

• Assessment: Usually normal
• Action: Assess if severe

E - Exposure

• Look: Abdominal examination
• Feel: Epigastric tenderness
• Action: Complete examination

Specific Examination Findings

Abdominal Examination:

• Inspection: Usually normal
• Palpation:
  • Epigastric tenderness: Common
  • No masses: Usually
  • No guarding: Usually (if guarding, think perforation)
• Percussion: Usually normal
• Auscultation: Normal bowel sounds

Signs of Bleeding (If Present):

• Pale: Anemia
• Tachycardia: If significant blood loss
• Hypotension: If significant blood loss

Special Tests

Natural History (Without Treatment)

Untreated Acute Gastritis:

• Most cases: Resolve spontaneously (weeks)
• Some cases: Become chronic
• Some cases: Progress to ulcers

Outcomes with Treatment

Factors Affecting Outcomes:

Good Prognosis:

• Early treatment: Better outcomes
• Cause removed: Complete recovery
• H. pylori treated: Prevents recurrence
• Mild cases: Usually resolve completely

Poor Prognosis:

• Cause not removed: May become chronic
• H. pylori not treated: May recur
• Severe cases: May progress to ulcers
• Bleeding: More serious, needs treatment

Prognostic Factors

Key Guidelines

1. NICE Guidelines (2014) — Dyspepsia and gastro-oesophageal reflux disease. National Institute for Health and Care Excellence

Key Recommendations:

• Clinical diagnosis for mild cases
• PPI for treatment
• Test and treat H. pylori
• Evidence Level: 1A

2. Maastricht V Consensus (2016) — H. pylori management. Gut

Key Recommendations:

• Test and treat H. pylori
• Triple therapy first-line
• Confirm eradication
• Evidence Level: 1A

Landmark Trials

Multiple studies on PPI efficacy, H. pylori treatment.

Evidence Strength

What is Acute Gastritis?

Acute gastritis is sudden inflammation of your stomach lining. Think of your stomach lining as a protective barrier—when it becomes inflamed, it can't protect itself from stomach acid, causing pain and discomfort. The most common causes are medications (especially painkillers like ibuprofen), alcohol, or infection (H. pylori bacteria).

In simple terms: Your stomach lining suddenly becomes inflamed, causing pain and discomfort in your upper abdomen. Most cases are mild and get better quickly with treatment.

Why does it matter?

Most cases of acute gastritis are mild and resolve completely with treatment. However, some can cause bleeding or progress to ulcers if not treated. The good news? With proper treatment (stopping the cause and taking acid-reducing medicines), most people recover completely within days to weeks.

Think of it like this: It's like your stomach getting irritated and inflamed—with the right care, it usually heals quickly.

How is it treated?

1. Remove the Cause (Most Important):

• If it's a medication: Stop the medication (with doctor's advice)
• If it's alcohol: Stop or reduce alcohol
• If it's stress: Try to reduce stress

2. Acid-Reducing Medicines:

• PPI medicines: Like omeprazole, reduce stomach acid and help your stomach lining heal
• Duration: Usually 4-8 weeks

3. Treat Infection (If Present):

• If H. pylori bacteria: You'll need antibiotics (usually 1-2 weeks) plus acid-reducing medicine
• This prevents: The gastritis from coming back

The goal: Remove what's causing it, help your stomach heal, and prevent it happening again.

What to expect

Recovery:

• Most cases: Start feeling better within days
• Pain: Usually improves within days to weeks
• Full recovery: Most people are back to normal within 2-4 weeks

After Treatment:

• Lifestyle: Avoid things that caused it (certain medications, excess alcohol)
• Medications: You may need to take acid-reducing medicines for a few weeks
• Follow-up: Usually not needed unless symptoms persist

Recovery Time:

• Mild cases: Usually recover within days to weeks
• Moderate cases: Usually recover within weeks
• Severe cases: May take longer, may need more treatment

When to seek help

See your doctor if:

• You have persistent upper abdominal pain
• You have nausea or vomiting that won't go away
• You're taking painkillers regularly and have stomach pain
• You have symptoms that concern you

Call 999 (or your emergency number) immediately if:

• You vomit blood
• You pass black, tarry stools
• You have severe abdominal pain
• You feel very unwell

Remember: If you have persistent stomach pain, especially if you're taking painkillers or drinking alcohol, see your doctor. Most cases are easily treated, but some can be more serious and need prompt attention.