When your stomach feels like it’s on fire after eating, or you’re constantly nauseous with no clear reason, it’s easy to blame stress or spicy food. But if these symptoms stick around, it might be something deeper: gastritis. This isn’t just an upset stomach-it’s inflammation of the stomach lining, and in most cases, it’s caused by a tiny bacterium called Helicobacter pylori. Left untreated, it can lead to ulcers, bleeding, or even increase your risk of stomach cancer. The good news? We know how to treat it effectively-if you know what to look for and when to act.
What Exactly Is Gastritis?
Gastritis means your stomach’s protective lining is irritated or swollen. That lining, called the mucosa, normally shields your stomach from its own strong acids and digestive enzymes. When it breaks down, those acids start eating away at the tissue underneath, causing pain, nausea, and sometimes bleeding. There are two main types: erosive and nonerosive. Erosive gastritis means there are actual sores or breaks in the lining-you might see blood in your vomit or black, tarry stools. Nonerosive gastritis doesn’t show visible damage, but the cells underneath are still changing, often slowly turning into something less functional over time.H. pylori: The Hidden Culprit Behind Most Cases
About 70 to 90% of all gastritis cases tied to ulcers are caused by Helicobacter pylori. This spiral-shaped bacteria lives in the stomach acid, something scientists once thought was impossible. It burrows into the mucus layer, weakens the lining, and tricks your immune system into thinking it’s not a threat. Over years, this silent invasion can turn mild irritation into chronic inflammation, atrophy (thinning of the stomach wall), and even precancerous changes. The discovery of H. pylori in 1982 by Barry Marshall and Robin Warren was a medical earthquake-they proved bacteria could survive in the stomach, and that this tiny bug was behind most peptic ulcers. They won the Nobel Prize for it in 2005.It’s not just about ulcers. H. pylori is linked to a 6- to 8-fold increase in gastritis risk. In parts of Asia and Africa, up to 80% of adults carry it. Even in the UK and US, about 1 in 4 people are infected, though many never know it because they have no symptoms. That’s the scary part: you can have it for decades without feeling anything-until one day, you start bleeding or develop a tumor.
Symptoms: When to Take It Seriously
Many people with chronic gastritis feel fine. But when symptoms do show up, they’re often vague and easy to ignore:- Upper abdominal pain or burning, especially after eating
- Nausea, sometimes with vomiting
- Bloating or feeling full too quickly
- Loss of appetite
- Unexplained weight loss
But if you see any of these, get help immediately:
- Black, sticky stools (like tar)-a sign of internal bleeding
- Vomiting blood or material that looks like coffee grounds
- Extreme fatigue, dizziness, or shortness of breath-signs of anemia from slow, ongoing blood loss
These aren’t normal. They mean your stomach lining is damaged enough to bleed, and you need urgent care. In the UK, the NHS recommends anyone over 55 with new-onset dyspepsia (indigestion) get tested for H. pylori or undergo endoscopy. But younger people with persistent symptoms shouldn’t wait either.
How Doctors Diagnose It
You can’t diagnose gastritis by feeling it. You need tests. The gold standard is an endoscopy: a thin, flexible tube with a camera is passed down your throat to look at your stomach. If the lining looks inflamed, the doctor takes tiny tissue samples (biopsies) to check for H. pylori and rule out cancer.But you don’t always need an endoscopy. Non-invasive tests are common:
- Urea breath test: You drink a special liquid, then breathe into a bag. If H. pylori is present, it breaks down the urea and releases carbon dioxide you can detect. It’s 95% accurate.
- Stool antigen test: Looks for H. pylori proteins in your poop. Easy, cheap, and reliable.
- Blood test: Checks for antibodies, but it can’t tell if you still have the infection-it only shows you’ve been exposed in the past.
Doctors usually start with breath or stool tests. If those are positive, treatment begins. If symptoms are severe or you’re over 55, they’ll go straight to endoscopy.
How H. pylori Is Treated: The Real Protocol
Treating H. pylori isn’t just popping an antacid. It’s a two-week battle with antibiotics. The standard is called triple therapy: one proton pump inhibitor (PPI) like omeprazole or esomeprazole, plus two antibiotics-usually amoxicillin and clarithromycin. This combo kills the bacteria and lets your stomach heal.But here’s the catch: antibiotics are failing more often. In the UK and US, clarithromycin resistance has jumped from 10% in 2000 to over 35% today. That means in many places, triple therapy only works 70-75% of the time. If you’ve tried it before and it didn’t work, you’re not alone-and you’re not broken. Your doctor needs to switch tactics.
Newer options are now available:
- Bismuth quadruple therapy: PPI + bismuth subsalicylate + metronidazole + tetracycline. Works better in high-resistance areas, with success rates of 85-92%.
- Vonoprazan-based therapy: A new acid blocker (approved in the US in 2022) that works faster and stronger than PPIs. In trials, it cleared H. pylori in over 90% of cases-even after two failed treatments.
Most patients take the meds for 10 to 14 days. It’s tough: antibiotics cause nausea, diarrhea, and a metallic taste. But sticking to the full course is critical. Missing even one dose can let the bacteria survive and become resistant. After treatment, you’ll need a follow-up breath or stool test 4 weeks later to confirm it’s gone. Don’t skip this. If it’s still there, you’ll need a different combo.
Other Causes of Gastritis (And How They’re Treated)
Not all gastritis is H. pylori. Other common triggers:- NSAIDs (ibuprofen, naproxen): These block protective chemicals in the stomach lining. About 25-30% of gastritis cases come from regular painkiller use. Stopping them is the first step-switch to acetaminophen if you need pain relief.
- Alcohol: More than 30g a day (about 2 standard drinks) doubles your risk. Cutting back or quitting can reduce symptoms by 60% in just two weeks.
- Autoimmune gastritis: Your immune system attacks your stomach cells, especially the ones that make intrinsic factor (needed for B12 absorption). This affects about 0.1% of people, but up to 5% of those with other autoimmune diseases like Hashimoto’s. Treatment? Lifelong vitamin B12 injections or high-dose oral supplements.
- Stress: Severe physical stress-like from major surgery, burns, or trauma-can cause acute erosive gastritis. This is rare in everyday life.
What You Can Do at Home
Medication helps, but lifestyle changes make the difference between temporary relief and long-term healing:- Avoid NSAIDs: Use paracetamol instead for headaches or muscle pain.
- Limit alcohol: Even moderate drinking can delay healing.
- Quit smoking: Smoking cuts healing rates by 35% and increases cancer risk.
- Eat smaller meals: Large meals stretch the stomach and worsen discomfort.
- Avoid spicy, acidic, or fried foods: They don’t cause gastritis, but they can irritate an already inflamed lining.
- Manage stress: While stress doesn’t cause H. pylori, it can make symptoms feel worse. Try walking, breathing exercises, or talking to someone.
What About Proton Pump Inhibitors (PPIs)?
PPIs like omeprazole are the backbone of treatment. They shut down stomach acid production, giving your lining time to heal. Most people feel better within a few days. But here’s the problem: many stay on them too long.After H. pylori is gone, you usually don’t need PPIs anymore. But 40% of patients who take them for more than 6 months experience rebound acid reflux when they stop. That means their stomach overproduces acid as a reaction, making them think they need to keep taking the drug. It’s a trap. Work with your doctor to taper off slowly-don’t just quit cold turkey.
Long-Term Outlook and Prevention
If you treat H. pylori early, your risk of stomach cancer drops by about 50%. That’s huge. But if you ignore it, the damage can become permanent. Atrophic gastritis (thinning of the stomach lining) can’t be reversed. Once you’ve lost acid-producing cells, you’re at higher risk for nutrient deficiencies and cancer.Prevention is simple: get tested if you have persistent symptoms, especially if you’re over 50 or have a family history of stomach cancer. In the UK, routine H. pylori screening isn’t offered to everyone-but it should be for anyone with unexplained dyspepsia. Don’t wait for a crisis.
And if you’ve been treated? Stay vigilant. Follow up with your doctor. Watch for symptoms returning. And remember: you’re not just treating a bug-you’re protecting your future.
Can gastritis go away on its own?
Sometimes, especially if it’s caused by a short-term trigger like alcohol or NSAIDs, mild gastritis can improve if you stop the irritant. But if H. pylori is the cause, it won’t go away without treatment. Left untreated, it can become chronic and lead to ulcers or cancer. Don’t rely on it resolving by itself.
Is H. pylori contagious?
Yes. H. pylori spreads through contaminated food, water, or close contact like kissing or sharing utensils. It’s often passed in childhood, especially in crowded or low-income households. Once you’re infected, it can stay for life unless treated. That’s why testing close family members after one person is diagnosed is often recommended.
How long does H. pylori treatment take to work?
Symptoms like pain and nausea often improve within a few days of starting treatment. But the full 10- to 14-day antibiotic course must be completed to kill the bacteria. Even if you feel better, stopping early increases the chance of failure and antibiotic resistance. Confirm eradication with a breath or stool test 4 weeks after finishing treatment.
Can I drink alcohol while being treated for gastritis?
No. Alcohol irritates the stomach lining and interferes with healing. It can also worsen side effects from antibiotics, like nausea and diarrhea. Avoid alcohol entirely during treatment and for at least 2 weeks after. Even after recovery, limiting alcohol helps prevent recurrence.
Are there natural remedies that cure gastritis?
No. While some people report relief from honey, probiotics, or cabbage juice, none have been proven to kill H. pylori or cure gastritis. Relying on these instead of medical treatment can delay diagnosis and allow damage to progress. Always combine natural support with doctor-approved treatment.
Will I need an endoscopy every time I have symptoms?
No. Once H. pylori is confirmed and treated, and symptoms improve, you usually don’t need another endoscopy unless symptoms return or you’re over 55 with new symptoms. For most people, breath or stool tests are enough for follow-up. Endoscopy is reserved for high-risk cases or when there’s concern about cancer.
What Comes Next?
If you’ve been diagnosed with gastritis and H. pylori, your next step is clear: start treatment. Don’t delay. If you haven’t been tested but have ongoing stomach issues, ask your GP for a urea breath test or stool antigen test. It’s quick, painless, and could prevent years of discomfort-or worse.Healing takes time. But with the right treatment, most people recover fully. The key is acting early, following through, and not letting silence be mistaken for safety.
