Gastritis: Understanding Stomach Lining Inflammation and H. pylori Treatment

When your stomach hurts after eating, or you feel nauseous without any clear reason, it might not just be indigestion. It could be gastritis - inflammation of the stomach lining. This isn’t a one-time glitch; it’s a condition that can creep up slowly or hit hard all at once. And in most cases, it’s tied to a tiny, sneaky bacteria called Helicobacter pylori (H. pylori).

What Exactly Is Gastritis?

Your stomach lining, or mucosa, is designed to handle strong acids and enzymes that break down food. But when it gets inflamed, that protective barrier weakens. This leads to burning pain, bloating, nausea, and sometimes vomiting. Gastritis isn’t one single disease - it’s a spectrum. Some people have acute gastritis, where symptoms pop up suddenly after drinking too much alcohol, taking NSAIDs like ibuprofen, or severe stress. Others have chronic gastritis, which develops over months or years, often without obvious signs until complications arise.

Doctors split gastritis into two main types: erosive and nonerosive. Erosive means there are actual breaks or sores in the stomach lining - these can bleed, leading to black, tarry stools or even vomiting blood. Nonerosive gastritis doesn’t show visible damage, but the cells underneath are changing. In about 30% of people with long-term H. pylori infection, the stomach lining starts thinning out, losing its ability to produce acid. This is called atrophic gastritis and raises the risk of stomach cancer.

The H. pylori Connection

More than 70% of all chronic gastritis cases come from H. pylori. This spiral-shaped bacterium lives in the stomach, burrowing into the mucus layer where most other germs can’t survive. It’s not just hanging out - it’s causing damage. The bacteria release toxins that irritate the stomach wall and trick the immune system into responding, leading to long-term inflammation.

What’s wild is that most people with H. pylori never know they have it. Up to half of those infected show no symptoms at all. But for others, it’s the root cause of ulcers, chronic pain, and even gastric cancer. In fact, treating H. pylori cuts the risk of stomach cancer by about 50%. That’s why experts now treat it - even if you’re not feeling sick - if you live in a high-risk area or have a family history of gastric cancer.

Here’s the catch: H. pylori is super common. In developing countries, up to 80% of adults carry it. In Australia, about 20-30% of the population is infected. The older you are, the more likely you’ve been exposed. It spreads through contaminated food, water, or close contact - like sharing utensils or kissing someone who carries it.

Symptoms: More Than Just an Upset Stomach

Not everyone with gastritis feels the same way. Acute cases often bring sharp upper abdominal pain, nausea, and vomiting. Chronic cases? Sometimes they’re silent. You might just feel full faster than usual, have bloating after small meals, or notice unexplained fatigue from low iron or B12 levels.

Red flags you shouldn’t ignore:

• Black, tarry stools - a sign of bleeding in the gut
• Vomiting blood or material that looks like coffee grounds
• Unexplained weight loss
• Persistent fatigue or shortness of breath - signs of anemia from slow bleeding

If you’re experiencing any of these, don’t wait. These aren’t normal digestive hiccups. They mean something more serious is happening.

How Is It Diagnosed?

Doctors don’t guess anymore. The gold standard is an endoscopy - a thin, flexible tube with a camera is passed down your throat to look at your stomach. Biopsies (tiny tissue samples) are taken to check for inflammation, H. pylori, or early signs of cancer.

But you don’t always need an endoscopy. Non-invasive tests are reliable:

• Urea breath test: You drink a special solution. If H. pylori is present, it breaks down the urea and releases carbon dioxide you exhale. This test is 95% accurate.
• Stool antigen test: Looks for H. pylori proteins in your poop.
• Blood test: Checks for antibodies, but can’t tell if the infection is current or past.

These tests are fast, painless, and widely available. No need to jump straight to an endoscopy unless you’re over 50, have a family history of stomach cancer, or are showing warning signs.

Treatment: Eradicating H. pylori

If H. pylori is the cause, treatment is straightforward - but not always easy. The standard is triple therapy: a proton pump inhibitor (PPI) like omeprazole or esomeprazole, plus two antibiotics - usually amoxicillin and clarithromycin - taken together for 10 to 14 days.

Success rates? Around 80-90% if you take every pill exactly as prescribed. But here’s the problem: antibiotic resistance is rising. In Australia and the U.S., clarithromycin resistance has jumped from 10% in 2000 to over 35% today. That means triple therapy fails more often than it used to.

That’s why doctors are switching tactics. In areas with high resistance, they use quadruple therapy: a PPI, bismuth (like Pepto-Bismol), metronidazole, and tetracycline. This works in 85-92% of cases. Another newer option is vonoprazan - a potassium-competitive acid blocker approved in 2022. It’s stronger at suppressing acid than PPIs and has shown 90%+ eradication rates in trials, even after failed treatments.

Side effects? Common ones include metallic taste, diarrhea, nausea, and stomach cramps. About 60% of patients report discomfort during treatment. But it’s temporary. The key is finishing the full course - even if you feel better after a few days. Stopping early invites resistant strains to survive.

What About Other Causes?

H. pylori isn’t the only culprit. NSAIDs like ibuprofen, naproxen, or aspirin can irritate the stomach lining, especially with long-term use. Alcohol, smoking, and severe stress (like after major surgery or burns) also trigger acute gastritis.

If NSAIDs are the problem, the fix is simple: stop or switch to a safer painkiller like acetaminophen. Add a PPI to protect your stomach while healing. For alcohol-related cases, cutting back or quitting can cut symptoms by 60% in just two weeks.

There’s also autoimmune gastritis - a rare form where your immune system attacks the stomach cells that make acid and intrinsic factor (needed for B12 absorption). This affects less than 1% of people but is more common in those with thyroid disease or type 1 diabetes. Treatment? Lifelong B12 injections.

Lifestyle Fixes That Actually Help

Treatment isn’t just pills. What you do outside the doctor’s office matters:

• Avoid NSAIDs: Use them sparingly. If you must take them, pair them with a PPI.
• Quit smoking: Smoking delays healing and increases cancer risk. Quitting improves healing by 35%.
• Limit alcohol: More than 30g/day (about 2 standard drinks) doubles your risk. Cut back or stop.
• Eat smaller meals: Large meals stretch the stomach, increasing pressure and discomfort.
• Avoid trigger foods: Spicy, acidic, or fried foods don’t cause gastritis but can make symptoms worse.

There’s no magic diet for gastritis. But many people find relief by eating more whole foods, less processed stuff, and avoiding eating right before bed.

What Happens After Treatment?

After finishing your antibiotics, you’re not done. You need confirmation that H. pylori is gone. That means a urea breath test or stool test 4 weeks after treatment ends. Why wait? Because the test can give false positives if done too soon - leftover bacteria or fragments can still show up.

If treatment fails? Don’t panic. Your doctor will try a different combo - maybe with different antibiotics or add vonoprazan. Some patients need two or three tries before it sticks.

Long-term PPI use? Many people stay on them for months or years. But beware: stopping suddenly can cause rebound acid production. That’s when your stomach overcompensates and makes even more acid than before. If you want to quit, do it slowly under medical supervision.

Why This Matters Now

Gastritis affects half a billion people worldwide. In Australia, the number of cases has been rising slowly, especially in older adults. But the real story is H. pylori’s role in cancer prevention. Treating it isn’t just about relieving pain - it’s about preventing death.

Experts predict that by 2030, better screening and tailored treatments could reduce H. pylori-related complications by 20%. But without action on antibiotic resistance, we risk seeing a comeback of ulcers and stomach cancer.

The message is clear: if you have chronic stomach issues, get tested. If you’re diagnosed with H. pylori, treat it fully. And if you’ve been on PPIs for years, talk to your doctor about whether you still need them.