Last updated: February 23, 2023

Summarytoggle arrow icon

Gastritis is an inflammatory process of the gastric mucosa that can be caused by a variety of conditions, commonly H. pylori infection or the use of drugs such as NSAIDs. Patients typically present with dyspepsia and can often be managed with a test-and-treat strategy for H. pylori if there are no indications for an upper endoscopy. Depending on the results, patients receive eradication therapy or a trial of pharmacological acid suppression. Upper endoscopy and biopsy, which can identify histopathological signs of inflammation, are required for definitive diagnosis. Upper endoscopy is indicated in patients over 60 years of age and considered on a case-by-case basis when red flags for dyspepsia are present. Often, gastritis is diagnosed incidentally, when upper endoscopy is performed for other reasons. The underlying cause of gastritis may be obvious (e.g., direct injury from medication intake), but further testing may be required in order to identify the etiology and provide the optimal treatment.

Definitiontoggle arrow icon

  • Gastritis: inflammation of the gastric mucosa, typically in response to H. pylori infection (H. pylori gastritis), direct injury (e.g., substance-induced gastritis), or as part of a systemic inflammatory disease [1]
  • Gastropathy: injury to the gastric mucosa, usually involving a disruption in the protective mucous barrier. In contrast to gastritis, gastropathy is accompanied by little to no inflammation.

Etiologytoggle arrow icon

Etiology of gastritis [2]
Mechanism Cause
External Infectious
Patient-related Systemic diseases

Helicobacter pylori infection is the most common cause of gastritis.

Classificationtoggle arrow icon

There are multiple classification systems for gastritis. There is significant overlap between different types, e.g., in the histopathological findings of acute and chronic gastritis. The most common types are described here. [1][2]

Clinical featurestoggle arrow icon

Subtypes and variantstoggle arrow icon

Acute hemorrhagic erosive gastropathy [1][5]

Reactive gastropathy [6]

Ménétrier disease [7][8]

Specific infiltrates

Differential diagnosestoggle arrow icon

The differential diagnoses listed here are not exhaustive.

Diagnosticstoggle arrow icon

Approach [4]

Although gastritis is diagnosed based on the results of gastric mucosal biopsy, not all patients require invasive diagnostic testing. For more detailed recommendations, see “Approach to dyspepsia.”

Esophagogastroduodenoscopy (EGD) with biopsies [1][4]

  • Endoscopic findings
  • Histopathologic findings: dependent on etiology

Treatmenttoggle arrow icon

Patients with upper GI symptoms are often treated empirically (see “Approach to dyspepsia”). If gastritis is confirmed by upper endoscopy, treatment should be tailored to the underlying etiology. [4]

Referencestoggle arrow icon

  1. Odze RD, Goldblum JR. Surgical Pathology of the GI Tract, Liver, Biliary Tract, and Pancreas. Elsevier Health Sciences ; 2009
  2. Rugge M, Sugano K, Sacchi D, Sbaraglia M, Malfertheiner P. Gastritis: An Update in 2020. Curr Treat Options Gastroenterol. 2020; 18 (3): p.488-503.doi: 10.1007/s11938-020-00298-8 . | Open in Read by QxMD
  3. Moayyedi PM, Lacy BE, Andrews CN, Enns RA, Howden CW, Vakil N. ACG and CAG Clinical Guideline: Management of Dyspepsia. Am J Gastroenterol. 2017; 112 (7): p.988-1013.doi: 10.1038/ajg.2017.154 . | Open in Read by QxMD
  4. Becker DJ, Sinclair J, Castell DO, Wu WC. A comparison of high and low fat meals on postprandial esophageal acid exposure. Am J Gastroenterol. 1989; 84 (7): p.782-786.
  5. Kaltenbach T, Crockett S, Gerson LB. Are Lifestyle Measures Effective in Patients With Gastroesophageal Reflux Disease?. Arch Intern Med. 2006; 166 (9): p.965.doi: 10.1001/archinte.166.9.965 . | Open in Read by QxMD
  6. Commisso A, Lim F. Lifestyle Modifications in Adults and Older Adults With Chronic Gastroesophageal Reflux Disease (GERD). Crit Care Nurs Q. 2019; 42 (1): p.64-74.doi: 10.1097/cnq.0000000000000239 . | Open in Read by QxMD
  7. Cook D, Guyatt G. Prophylaxis against Upper Gastrointestinal Bleeding in Hospitalized Patients. N Engl J Med. 2018; 378 (26): p.2506-2516.doi: 10.1056/nejmra1605507 . | Open in Read by QxMD
  8. Pashankar DS, Bishop WP, Mitros FA. Chemical Gastropathy: A Distinct Histopathologic Entity in Children. J Pediatr Gastroenterol Nutr. 2002; 35 (5): p.653-657.doi: 10.1097/00005176-200211000-00012 . | Open in Read by QxMD
  9. Genta RM. Differential diagnosis of reactive gastropathy. Semin Diagn Pathol. 2005; 22 (4): p.273-283.doi: 10.1053/j.semdp.2006.04.001 . | Open in Read by QxMD
  10. Longo D, Fauci A, Kasper D, Hauser S, Jameson J, Loscalzo J. Harrisons's Principles of Internal Medicine, 18th Edition, 2011. McGraw-Hill Medical ; 2011
  11. Nils W. G. Lambrecht. Ménétrier’s Disease of the Stomach: A Clinical Challenge. Curr Gastroenterol Rep. 2011; 13 (6): p.513-517.doi: 10.1007/s11894-011-0222-8 . | Open in Read by QxMD
  12. Hauser SC, Pardi DS, Poterucha JJ. Mayo Clinic Gastroenterology and Hepatology Board Review. CRC Press ; 2005
  13. Chey WD, Leontiadis GI, Howden CW, Moss SF. ACG Clinical Guideline: Treatment of Helicobacter pylori Infection. Am J Gastroenterol. 2017; 112: p.212-238.doi: 10.1038/ajg.2016.563 . | Open in Read by QxMD
  14. Ahmed Madisch, Viola Andresen, Paul Enck, Joachim Labenz, Thomas Frieling, Michael Schemann. The Diagnosis and Treatment of Functional Dyspepsia. Deutsches Aerzteblatt Online. 2018.doi: 10.3238/arztebl.2018.0222 . | Open in Read by QxMD
  15. Lymphocytic gastritis. Updated: December 11, 2019. Accessed: March 19, 2020.
  16. Prussin C. Eosinophilic Gastroenteritis and Related Eosinophilic Disorders. Gastroenterol Clin North Am. 2014; 43 (2): p.317-327.doi: 10.1016/j.gtc.2014.02.013 . | Open in Read by QxMD

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