Gastritis and Gastric Ulcer

First you should understand what causes gastritis and gastric and duodenal ulcer.

Before anything else, we must define what gastritis and ulcer are, affecting either the stomach or duodenum. Gastritis is an inflammation of the epithelium of stomach, i.e., the tissue layer overlying it. This acts as a mucosal lining consisting of a fabric resistant to intense acidity, which makes sense since the material contained in the stomach has extremely low pH. Ulcer, as its name implies, is an ulcer (or erosion) in the epithelium, like a big cold sore. Ulcer is called gastric when it affects the stomach, duodenum and when it presents the duodenum (the first portion of small intestine).



Gastritis is not a single disease. It is, in fact, the final result of various types of injury to the stomach. Causes of gastritisare as follows:

• Prolonged use of anti-inflammatory drugs
• Reflux of bile into the stomach
• Large physical stresses such as trauma, burns, major surgery, sepsis, etc.
• Alcohol abuse
• Prolonged use of acetylsalicylic acid (Aspirin)
• Chemotherapy or radiotherapy
• Autoimmune gastritis
• Infection with the bacterium Helicobacter pylori
• Chronic renal failure
• Parasites
• Food poisoning
• Cigarettes

Gastritis is manifested by symptoms such as heartburn, pain in the "pit of the stomach," nausea, oversaturation and belching (burping).

These symptoms are framed in a picture called dyspepsia. Importantly, the severity of the symptoms does not necessarily correlate with the severity of gastritis or the presence of an ulcer. You may not even have dyspepsia and endoscopy may have no signs of gastritis, but you canhave an ulcer and hardly feel uncomfortable.

When there are no symptoms and no visible lesions in the stomach / duodenum, i.e. no gastritis, it is called functional dyspepsia, it is clinical gastritis / ulcer without these lesions. The functional dyspepsia is responsible for the situation which is wrongly called nervous gastritis.
There is nervous gastritis. Unlike physical stress, emotional stress alone is not a cause of lesions in the stomach or duodenum. Stressful situations can trigger symptoms of dyspepsia; they may also delay the healing of existing lesions, but individually cannot cause gastritis or ulcer.

Gastritis can be acute, when it develops quickly, or chronic, when the inflammation settles slowly and persists for several months. The first is usually caused by alcohol, drugs and food poisoning. The second tends to be caused by the H. pylori.

The gastritis left untreated can progress to erosions of the stomach mucosa, leading to formation of ulcers.


Peptic ulcers are those caused by the action of gastric juice in the wall of the duodenum, stomach or esophagus. The two main causes are inflammatory and abuse of H. pylori infection.

The new anti-inflammatory drugs called COX-2 inhibitors are less harmful to the stomach / duodenum, however, are not 100% safe. Although they can cause ulcers-less effectively, the use of COX-2 prevents wound healing from those ulcers that are already present.

Duodenal ulcers are more common than gastric and affect mainly individuals between 30 and 50 years of age. Gastric ulcers are more common for people over 60 years.

Ulcers can complicate causing perforations or bleeding. Peptic ulcers do not cause cancer, but some cancers can cause something similar to an ulcer. The lesser curvature of gastric ulcers is the most worthy of attention because it is at this point where the tumors tend to arise.

A little symptomatic ulcer is often responsible for anemia without an apparent cause. The bleeding can be small and not noticeable to the naked eye, but an ulcer may cause a hemorrhage, being sufficient to have loss of fresh blood through the mouth or faeces.


The diagnosis is made by endoscopy. Once detected, you should always biopsy ulcer, even if that does not display characteristics of cancer. Do not rule out neoplasia is safe only by the appearance of the lesion.

The research of H. pylori should be made only in the presence of ulcers. Despite this statement, many doctors still do research the bacteria even when there are only signs of gastritis. One should not search because there is no indication of H. pylori without ulcer.

The reports of endoscopies often cause some degree of confusion. First it is important to know the anatomy of the stomach.

Some common questions:

• When you say antral gastritis or den, that means inflammation of the final portion of the stomach (see diagram above).
• The term enanthematous means a mucosa injury. So enanthematousantral gastritis is an inflammation of the mucosal lesion in the antrum region.
• Pangastritis means a diffuse inflammation, affecting most of the stomach.

Treatment today is done with suppression of gastric acidity. There are two classes of drugs for this purpose:

• H2 receptor antagonist - Ranitidine
• Proton pump inhibitors (PPIs) - omeprazole, pantoprazole, lansoprazole etc.

Preference is given to the proton pump inhibitor as it tends to be more effective. To help to cure the disease one should cut tobacco and booze. As already mentioned, the treatment of H. pylori is only indicated if there is ulcer. There is no evidence that H. pylori eradication in gastritis alone bring any benefit. The treatment is done for at least 4 weeks.