Gastritis

1. What is gastritis?

Gastritis is a morphologically confirmed inflammation of the gastric mucosa, characterized by infiltration with inflammatory cells, epithelial damage, and in some cases, atrophic changes.

There are two main types:

• Acute gastritis – sudden onset inflammation, often reversible;
• Chronic gastritis – a long-standing inflammatory process that may lead to atrophy and metaplasia.

2. Etiology and risk factors of gastritis

Primary causes:

·    Helicobacter pylori (H. pylori) — the most common cause of chronic gastritis (according to Maastricht VI guidelines, responsible for >80% of cases);
·    Nonsteroidal anti-inflammatory drugs (NSAIDs) — disrupt the protective mucosal barrier by inhibiting prostaglandins;
·    Alcohol — exerts direct toxic and irritative effects;
·    Autoimmune gastritis — predominantly affects women; associated with pernicious anemia, vitamin B12 deficiency, and antibodies to parietal cells and intrinsic factor;
·    Physiological stress (e.g., severe trauma, burns, sepsis): stress-induced acute gastritis;
·    Bile reflux (e.g., in postcholecystectomy syndrome).

Risk factors:

·    NSAID or glucocorticoid use without gastroprotection
·    Smoking
·    Poor dietary habits
·    Chronic alcoholism
·    Family history of gastric cancer or autoimmune disorders

3. Types and classification of gastritis

Clinical-etiological classification:

Acute gastritis:
·    Catarrhal
·    Erosive (including drug-induced or alcohol-related)
·    Phlegmonous (rare, bacterial)
·    Necrotic

Chronic gastritis:
·    H. pylori-associated
·    Autoimmune
·    Chemically induced (e.g., bile reflux, NSAIDs)
·    Idiopathic
·    Atrophic gastritis — characterized by mucosal thinning, gland loss, and functional insufficiency

4. Clinical manifestations

Gastritis may be asymptomatic or present with the following complaints:
·    Epigastric pain or discomfort
·    Nausea, belching, early satiety
·    Bloating
·    Loss of appetite
·    In some cases — hematemesis (in erosive forms), melena
·    In autoimmune gastritis — signs of B12-deficiency anemia: fatigue, paresthesia, glossitis

5. Diagnosis of gastritis

1.    Esophagogastroduodenoscopy (EGD) — gold standard for diagnosis; allows direct visualization of mucosa and biopsy sampling
2.    Histological examination (using OLGA/OLGIM classifications) — confirms inflammation, atrophy, or intestinal metaplasia
3.    H. pylori testing:
    Urea breath test (¹³C or ¹⁴C) — most sensitive non-invasive method
    Stool antigen test (ELISA)
    Serology (IgG) — less specific, not suitable for confirming eradication
    Rapid urease test on biopsy specimen
    PCR for H. pylori in biopsy samples
4.    CBC, vitamin B12, iron, ferritin — if autoimmune gastritis is suspected
5.    pH-metry and Schilling test — in specific clinical situations

6. Modern approaches to treatment

·    H. pylori eradication therapy (according to Maastricht VI)
·    Diet avoiding irritant foods (fried, spicy, alcohol, coffee, etc.)

7. Complications and prevention

Complications:
·    Peptic ulcer disease of the stomach and duodenum
·    Gastrointestinal bleeding
·    Pernicious anemia
·    Mucosal dysplasia and gastric cancer (especially in H. pylori infection with atrophy)

Prevention:
·    Eradication of H. pylori when infection is confirmed
·    Avoiding long-term NSAID use without protective therapy
·    Healthy diet, alcohol and smoking cessation
·    Endoscopic surveillance in patients with atrophy or intestinal metaplasia

8. Gastritis and pregnancy

During pregnancy, gastritis may worsen due to:
·    Hormonal changes (elevated progesterone slows gastrointestinal motility)
·    Organ displacement caused by the growing uterus

9. When to see a doctor

·    Persistent or severe epigastric pain
·    Nausea and vomiting, especially with blood
·    Weight loss, anemia
·    Symptoms of vitamin B12 deficiency
·    History of gastritis and planning pregnancy
·    Family history of gastric cancer

Meri Soghoyan, Gastroenterologist, hepatologist

Meri Soghoyan

 

Education

• Yerevan state Medical University named after Mkhitar Heratsi, 2014-2020
• Mikaelyan Institute of Surgery, clinical residency of gastroenterology and hepatology, 2020-2022

 

Professional Activity

• Mikaelyan Institute of Surgery, duty therapist, 10.2021-09.2022
• “Armenia” Republican medical center, Gastroenterologist, hepatologist 10.2022-03.2023
• “Cito” MC, Gastroenterologist, hepatologist, 03.2023 - currently
• “Gastro clinic” Specialized center of gastroenterology, Gastroenterologist, hepatologist, 05.2023 - currently

 

Certificates

• Nutrition and weight adjustment consultant. The basis of practical nutrition and dietetics.
• Nutritional consultant. Practical dietetics and nutrition, professional level. Psychology of counseling the customer who is on a diet
• Nutritionist 2022

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