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Gastroenterology383 papers

Gastritis

Last edited: 4/13/2026

Overview

Gastritis is characterized by inflammation of the gastric mucosa, often requiring histological confirmation for accurate diagnosis. It can be caused by various factors, with Helicobacter pylori being a predominant etiological agent, though other causes exist 136.

Diagnosis

  • Histological Confirmation: Essential for definitive diagnosis 1.
  • Biopsy: Gastric mucosal biopsy is crucial for assessing inflammation and identifying specific causes 18.
  • Endoscopy: Useful for visual assessment and obtaining biopsies 2232.
  • H. pylori Testing: Serology, urea breath test, or stool antigen tests to detect infection 633.
  • Grading: Histopathological grading systems differentiate between acute and chronic inflammation 19.

    • Management

  • H. pylori Eradication: First-line treatment for H. pylori-associated gastritis using triple therapy (proton pump inhibitor + two antibiotics) 644.
  • Proton Pump Inhibitors (PPIs): For symptom relief and reducing gastric acid secretion 26.
  • Symptomatic Relief: Antacids or H2 receptor antagonists for mild symptoms 6.
  • Monitoring: Regular follow-up to assess response to treatment and recurrence 6.

    • Special Populations

  • Pediatrics: H. pylori infection prevalent; eradication therapy similar to adults but dose adjusted 2022.
  • Elderly: Consider comorbidities and potential drug interactions when prescribing eradication therapy 6.
  • Comorbidities: Manage carefully in patients with concurrent liver disease due to potential drug metabolism issues 2.

    • Key Recommendations

  • Histological Confirmation Required for Diagnosis: Essential for accurate identification of gastritis 1.
  • H. pylori Testing and Eradication Therapy: Recommended for confirmed H. pylori infection to prevent complications 644 (Evidence: Strong).
  • Use of PPIs for Symptom Management: Effective in reducing gastric acid and alleviating symptoms 26 (Evidence: Moderate).
  • Regular Follow-Up Post-Treatment: Important to monitor for treatment efficacy and recurrence 6 (Evidence: Moderate).
  • Consider Age-Specific Adjustments in Therapy: Tailor treatment in pediatric and elderly populations 2026 (Evidence: Expert opinion).

    • References

    1 Ramis Estelrich MD, Sánchez Fernández WD, Vaquer Grimalt P, Blanco Rodríguez S, García García M, Gómez López MP et al.. Infrequent gastritis: it's not always Helicobacter pylori. Revista espanola de enfermedades digestivas 2025. link 2 Adachi K, Ohyama K, Tanaka Y, Murayama N, Shimizu M, Saito Y et al.. Modeled Hepatic/Plasma Exposures of Omeprazole Prescribed Alone in Cytochrome P450 2C19 Poor Metabolizers Are Likely Associated with Hepatic Toxicity Reported in a Japanese Adverse Event Database. Biological & pharmaceutical bulletin 2024. link 3 Kang SJ, Kim JG, Moon HS, Kook MC, Lee JY, Bang CS et al.. Clinical Practice Guideline for Gastritis in Korea. Journal of Korean medical science 2023. link 4 Macke L, Schulz C, Malfertheiner P. The Fear of Gastric Cancer in Patients with Dyspepsia: Challenge in Specialist Care Gastroenterology. Digestive diseases (Basel, Switzerland) 2022. link 5 Kokkinou E, Mjösberg J. Tummy Time for ILC2. Immunity 2020. link 6 Fernández Salazar L, Valle Muñoz J. Treating Helicobacter pylori infection in the face of growing antibiotic resistance. Revista espanola de enfermedades digestivas 2019. link 7 Zendehdel A, Roham M. Biological evidence of the relationship between Helicobacter pylori and associated extragastric diseases. Journal of cellular biochemistry 2019. link 8 Parra Vargas V, Aponte DM, Álvarez EA. Unusual presentation of infection by Helicobacter pylori: gastritis associated with Russell bodies, infrequent and poorly understood pathology. Revista espanola de enfermedades digestivas 2017. link 9 Noto JM, Peek RM. Helicobacter pylori Makes a Molecular Incision to Gain Epithelial Entry. Cell host & microbe 2017. link 10 Wang H, Yao Y, Ni B, Shen Y, Wang X, Shen H et al.. Helicobacter pylori CagI is associated with the stability of CagA. Microbial pathogenesis 2016. link 11 Wroblewski LE, Peek RM. Helicobacter pylori: Pathogenic enablers - toxic relationships in the stomach. Nature reviews. Gastroenterology & hepatology 2016. link 12 Kariya S, Okano M, Nishizaki K. An association between Helicobacter pylori and upper respiratory tract disease: fact or fiction?. World journal of gastroenterology 2014. link 13 Fock KM, Graham DY, Malfertheiner P. Helicobacter pylori research: historical insights and future directions. Nature reviews. Gastroenterology & hepatology 2013. link 14 Karabagli P, Gokturk HS. Russell body gastritis: case report and review of the literature. Journal of gastrointestinal and liver diseases : JGLD 2012. link 15 Clancy CD, Forde BM, Moore SA, O'Toole PW. Draft genome sequences of Helicobacter pylori strains 17874 and P79. Journal of bacteriology 2012. link 16 Behrens W, Bönig T, Suerbaum S, Josenhans C. Genome sequence of Helicobacter pylori hpEurope strain N6. Journal of bacteriology 2012. link 17 Gunasekara S, Vrielink A, Stubbs KA. Preliminary studies into the inhibition of the cholesterol alpha-glucosyltransferase from Helicobacter pylori using azasugars. Carbohydrate research 2010. link 18 Mahjoub F, Khademalhosseini M, Monajemzadeh M, Sani MN. Significance of deep section in small gastric biopsies. Indian journal of pathology & microbiology 2009. link 19 Talebkhan Y, Mohammadi M, Rakhshani N, Abdirad A, Fayaz Moughadam K, Fereidooni F. Interobserver variations in histopathological assessment of gastric pathology. Pathology 2009. link 20 Pello S, Miller A, Ku T, Wang D. Hemorrhagic gastritis and duodenitis following celiac plexus neurolysis. Pain physician 2009. link 21 Pietroiusti A, Galante A, Magrini A, Bergamaschi A. Helicobacter pylori interference with micronutrients and orally administered drugs: a new mechanism explaining its role in extragastric disorders. Mini reviews in medicinal chemistry 2008. link 22 Kalinski T, Zwönitzer R, Sel S, Evert M, Guenther T, Hofmann H et al.. Virtual 3D microscopy using multiplane whole slide images in diagnostic pathology. American journal of clinical pathology 2008. link 23 Kang HM, Kim N, Park YS, Hwang JH, Kim JW, Jeong SH et al.. Effects of Helicobacter pylori Infection on gastric mucin expression. Journal of clinical gastroenterology 2008. link 24 Linz B, Schuster SC. Genomic diversity in Helicobacter and related organisms. Research in microbiology 2007. link 25 Desai HG. Investigations proposed to accurately classify chronic gastritis. The Journal of the Association of Physicians of India 2007. link 26 Pajares JM, Gisbert JP. Helicobacter pylori: its discovery and relevance for medicine. Revista espanola de enfermedades digestivas 2006. link 27 Van Der Weyden MB, Armstrong RM, Gregory AT. The 2005 Nobel Prize in physiology or medicine. The Medical journal of Australia 2005. link 28 Xiang Z, Si JM, Huang HD. Chronic gastritis rat model and role of inducing factors. World journal of gastroenterology 2004. link 29 Dipaola G, Camoglio FS, Giacomello L, Balducci T, Chironi C, Ottolenghi A. Complicated total esophagogastric dissociation: case report. La Pediatria medica e chirurgica : Medical and surgical pediatrics 2003. link 30 Fera MT, Carbone M, Buda C, Aragona M, Panetta S, Giannone M et al.. Correlation between Helicobacter pylori infection and IL-18 mRNA expression in human gastric biopsy specimens. Annals of the New York Academy of Sciences 2002. link 31 Marshall B. Gastric spirochaetes: 100 years of discovery before and after Kobayashi. The Keio journal of medicine 2002. link 32 Kaur G, Raj SM. A study of the concordance between endoscopic gastritis and histological gastritis in an area with a low background prevalence of Helicobacter pylori infection. Singapore medical journal 2002. link 33 Choudhary CK, Bhanot UK, Agarwal A, Garbyal RS. Correlation of H. pylori density with grading of chronic gastritis. Indian journal of pathology & microbiology 2001. link 34 Young DG. A stain for demonstrating Helicobacter pylori in gastric biopsies. Biotechnic & histochemistry : official publication of the Biological Stain Commission 2001. link 35 Martinez M, Kordisch F, Lesser S. The prevalence of Helicobacter pylori: are emergency medicine residents at risk?. The Journal of emergency medicine 2000. link00229-8) 36 Covacci A, Telford JL, Del Giudice G, Parsonnet J, Rappuoli R. Helicobacter pylori virulence and genetic geography. Science (New York, N.Y.) 1999. link 37 Day AS, Sherman PM. Understanding disease outcome following acquisition of Helicobacter pylori infection during childhood. Canadian journal of gastroenterology = Journal canadien de gastroenterologie 1999. link 38 Fährmann M, Jacob P, Seidler U, Osterhoff M, Möhlig M, Pfeiffer A. Ca2+/calmodulin-dependent protein kinase II isoenzymes gamma and delta are both present in H+/K+-ATPase-containing rabbit gastric tubulovesicles. European journal of biochemistry 1999. link 39 Beales IL, Calam J. Pathogenic mechanisms in Helicobacter pylori infection. Hospital medicine (London, England : 1998) 1998. link 40 Bardhan PK, Sarker SA, Mahalanabis D, Rahman MM, Hildebrand P, Beglinger C et al.. Helicobacter pylori infection in infants and children of Bangladesh. Praxis 1998. link 41 Gasbarrini A, Franceschi F, Gasbarrini G, Pola P. Extraintestinal pathology associated with Helicobacter infection. European journal of gastroenterology & hepatology 1997. link 42 Hill M. The microbiology of Helicobacter pylori. Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie 1997. link85584-9) 43 Mizote T, Yoshiyama H, Nakazawa T. Urease-independent chemotactic responses of Helicobacter pylori to urea, urease inhibitors, and sodium bicarbonate. Infection and immunity 1997. link 44 Freston JW. What remaining questions regarding Helicobacter pylori and associated diseases should be addressed by future research? View from North America. Gastroenterology 1997. link80032-7) 45 Mégraud F. Helicobacter pylori: bacterial factors and interaction with the epithelial cells. The Yale journal of biology and medicine 1996. link 46 Howden CW. Clinical expressions of Helicobacter pylori infection. The American journal of medicine 1996. link80226-9) 47 Stolte M, Eidt S. Helicobacter pylori and the evolution of gastritis. Scandinavian journal of gastroenterology. Supplement 1996. link 48 Wabinga HR. Frequency of Helicobacter pylori in gastroscopic biopsy of Ugandan Africans. East African medical journal 1996. link 49 Kimura K, Satoh K, Ido K, Taniguchi Y, Takimoto T, Takemoto T. Gastritis in the Japanese stomach. Scandinavian journal of gastroenterology. Supplement 1996. link 50 Mosquera RA, González C, Torres E, Rubio C. Prevalence of Helicobacter pylori at antral mucosa of patients with dyspepsia at University District Hospital. Boletin de la Asociacion Medica de Puerto Rico 1996. link 51 Aanpreung P, Atisook K, Suwangool P, Theerabutra C, Vajaradul C. Helicobacter pylori infection in Thai children with recurrent abdominal pain. Journal of the Medical Association of Thailand = Chotmaihet thangphaet 1996. link 52 Ashorn M. What are the specific features of Helicobacter pylori gastritis in children?. Annals of medicine 1995. link 53 Nagral S, Mohandas KM, Narawane N, Joshi A, Patankar T. Helicobacter pylori gastritis masquerading as gastric lymphoma. Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology 1995. link 54 Levine MS. Erosive gastritis and gastric ulcers. Radiologic clinics of North America 1994. link 55 Holcombe C, Kaluba J, Lucas SB. Helicobacter pylori infection and gastritis in healthy Nigerians. European journal of epidemiology 1994. link 56 Muller MJ, Hunt RH. Inflammation, acid and ulcers. The Yale journal of biology and medicine 1994. link 57 Eidt S, Stolte M. Antral intestinal metaplasia in Helicobacter pylori gastritis. Digestion 1994. link 58 Bashir MS, Lewis FA, Quirke P, Lee A, Dixon MF. In situ hybridisation for the identification of Helicobacter pylori in paraffin wax embedded tissue. Journal of clinical pathology 1994. link 59 Satoskar A, Vora IM. Incidence of Helicobacter pylori associated gastritis in the urban population from India. Tropical and geographical medicine 1994. link 60 Quak SH, Wee A, Quah TC, Quek SC, Lam SK. Helicobacter pylori infection in children with recurrent abdominal pain. Annals of tropical paediatrics 1994. link 61 Ricci V, Sommi P, Cova E, Fiocca R, Romano M, Ivey KJ et al.. Na+,K(+)-ATPase of gastric cells. A target of Helicobacter pylori cytotoxic activity. FEBS letters 1993. link81703-3) 62 Misiewicz JJ. Helicobacter pylori: past, present, and future. Scandinavian journal of gastroenterology. Supplement 1992. link 63 Cover TL, Blaser MJ. Helicobacter pylori and gastroduodenal disease. Annual review of medicine 1992. link 64 Heatley RV. Review article: the treatment of Helicobacter pylori infection. Alimentary pharmacology & therapeutics 1992. link 65 Bartel H, Orkisz S, Chojnacki J, Kulig A. Some ultrastructural aspects of Helicobacter pylori gastritis. Patologia polska 1992. link 66 Desai HG, Gill HH. What does the absence of Helicobacter pylori from the antrum imply?. Journal of clinical gastroenterology 1991. link 67 Leunk RD. Production of a cytotoxin by Helicobacter pylori. Reviews of infectious diseases 1991. link 68 Wyatt JI. Gastritis and its relation to gastric carcinogenesis. Seminars in diagnostic pathology 1991. link 69 Ahmed N, Malur PR, Sankapal MN, Nagalotimath SJ. Prevalence of Campylobacter pylori in non-ulcerative dyspepsia. Indian journal of pathology & microbiology 1991. link 70 Kazi JI, Jafarey NA, Alam SM, Zuberi SJ, Kazi AM, Qureshi H et al.. Association of Helicobacter pylori with acid peptic disease in Karachi. JPMA. The Journal of the Pakistan Medical Association 1990. link 71 Fukuda T, Kimura S, Arakawa T, Kobayashi K. Possible role of leukotrienes in gastritis associated with Campylobacter pylori. Journal of clinical gastroenterology 1990. link 72 O'Toole PA, Morris JA. Acute phlegmonous gastritis. Postgraduate medical journal 1988. link 73 Avilés JF, Fernández-Seara J, Bárcena R, Domíinguez F, Fernández C, Ledo L. Localized phlegmonous gastritis: endoscopic view. Endoscopy 1988. link 74 Hayashi K, Agata K, Mochii M, Yasugi S, Eguchi G, Mizuno T. Molecular cloning and the nucleotide sequence of cDNA for embryonic chicken pepsinogen: phylogenetic relationship with prochymosin. Journal of biochemistry 1988. link 75 Tytgat GN, Rauws EA. Significance of Campylobacter pylori. Alimentary pharmacology & therapeutics 1987. link 76 Koop H, Schubert B, Schwarting H, Schikierka D, Eissele R, Willemer S et al.. Increased visualization of antral gastrin-producing G-cells after acute stimulation of gastrin release in the rat. European journal of clinical investigation 1987. link 77 Jain DK, Wolfe MM, McGuigan JE. Functional and anatomical relationships between antral gastrin cells and gastrin-releasing peptide neurons. Histochemistry 1985. link 78 Varndell IM, Harris A, Tapia FJ, Yanaihara N, De Mey J, Bloom SR et al.. Intracellular topography of immunoreactive gastrin demonstrated using electron immunocytochemistry. Experientia 1983. link 79 Suzuki S, Furihata C, Tsuyama S, Murata F. Immunocytochemical localization of pepsinogen in rat stomach. Histochemistry 1983. link 80 Thomas WE. Effect of truncal vagotomy on functional and morphological changes produced by duodenogastric reflux. Digestive diseases and sciences 1982. link 81 Larsen KR, Moody FG, Cheung LY. Controlled intragastric pH and cimetidine inhibition of histamine-stimulated gastric acid secretion in the dog. Surgery 1981. link 82 Wiston TS. Emphysematous gastritis: report of a case. The Australian and New Zealand journal of surgery 1975. link

    Original source

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      Modeled Hepatic/Plasma Exposures of Omeprazole Prescribed Alone in Cytochrome P450 2C19 Poor Metabolizers Are Likely Associated with Hepatic Toxicity Reported in a Japanese Adverse Event Database. — Adachi K, Ohyama K, Tanaka Y, Murayama N, Shimizu M, Saito Y et al. Biological & pharmaceutical bulletin (2024)
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      Clinical Practice Guideline for Gastritis in Korea. — Kang SJ, Kim JG, Moon HS, Kook MC, Lee JY, Bang CS et al. Journal of Korean medical science (2023)
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      The Fear of Gastric Cancer in Patients with Dyspepsia: Challenge in Specialist Care Gastroenterology. — Macke L, Schulz C, Malfertheiner P Digestive diseases (Basel, Switzerland) (2022)
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      Tummy Time for ILC2. — Kokkinou E, Mjösberg J Immunity (2020)
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      Biological evidence of the relationship between Helicobacter pylori and associated extragastric diseases. — Zendehdel A, Roham M Journal of cellular biochemistry (2019)
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      Unusual presentation of infection by Helicobacter pylori: gastritis associated with Russell bodies, infrequent and poorly understood pathology. — Parra Vargas V, Aponte DM, Álvarez EA Revista espanola de enfermedades digestivas (2017)
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      Effects of Helicobacter pylori Infection on gastric mucin expression. — Kang HM, Kim N, Park YS, Hwang JH, Kim JW, Jeong SH et al. Journal of clinical gastroenterology (2008)
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