2. Gastritis

📄 Definition

Gastritis refers to inflammation of the gastric mucosa, which may be acute or chronic. It can be caused by infection, irritants, autoimmune disease, or other systemic conditions.

🛡️ Aetiology / Risk Factors (Mnemonic: HANGING)

  • Helicobacter pylori infection

  • Autoimmune gastritis (anti-parietal cell / intrinsic factor antibodies)

  • NSAIDs or aspirin

  • Glucocorticoids (especially with NSAIDs)

  • Irritants: alcohol, caffeine, spicy food

  • Nicotine (smoking)

  • Gastro-oesophageal reflux (associated)

📋 Clinical Features (Mnemonic: PAINED)

  • Post-prandial epigastric pain

  • Anaemia (from chronic GI blood loss in erosive gastritis)

  • Indigestion / dyspepsia

  • Nausea and/or vomiting

  • Early satiety or bloating

  • Dark stools (melaena) in haemorrhagic cases

Note: Symptoms often overlap with peptic ulcer disease and functional dyspepsia.

⚠️ Alarm Features (Mnemonic: ALARM55)

Refer for urgent OGD if the patient presents with:

  • Anaemia (iron deficiency)

  • Loss of weight

  • Anorexia

  • Recent-onset dysphagia

  • Melaena or haematemesis

  • Age ≥55 with new-onset symptoms

🔬1. 📍 Initial Clinical Assessment

  • Exclude red flags: dysphagia, weight loss, anaemia, vomiting, GI bleeding, mass, or family history of GI cancer.

  • Assess for NSAID use, alcohol, smoking, or stress.

  • Consider overlap with GORD, PUD, or functional dyspepsia.

2. 🧫 H. pylori Testing — When to Test?

✅ Test for H. pylori if:

  • Uninvestigated dyspepsia (especially <55 years and no red flags)

  • Symptoms persist after PPI trial

  • Previous history of gastric/duodenal ulcer or gastritis

  • Planned long-term NSAID use, especially in patients >45 years

  • Known iron-deficiency anaemia, or ITP/B12 deficiency

❌ Do NOT routinely test:

  • If asymptomatic and no history of ulcers or risk factors

  • During/after recent PPI use unless stopped for 2 weeks

  • In patients with alarming features — refer for OGD instead

3. 🧪 H. pylori Testing — Which Test to Use?

TestWhen to UseNotes
Urea Breath Test (UBT)1st-lineStop PPI ≥2 weeks prior
Stool Antigen Test1st-linePreferred in primary care
Serology (Blood Test)AvoidNot reliable for active infection
OGD + BiopsyIf red flags or treatment failureAlso rules out malignancy, ulcers

🔁 Follow-Up Testing

  • Confirm eradication 4 weeks after completing triple therapy (if given) using urea breath test or stool antigen — not serology.

🔎 Summary for PARA:

Test H. pylori in persistent dyspepsia without alarm features. Use stool antigen or breath test (PPIs stopped 2 weeks prior). Do not test if alarm symptoms present — refer for endoscopy.

💊 Treatment  –

1️⃣ Lifestyle First

  • Stop NSAIDs (if safe), reduce alcohol/caffeine, stop smoking

  • Antacids or alginates for symptom relief

2️⃣ Empirical PPI Trial

  • Omeprazole 20 mg OD for 4 weeks

  • First-line for uncomplicated dyspepsia

  • If symptoms resolve → step down/stop

3️⃣ Test for H. pylori

  • Only if symptoms persist after PPI

  • Stop PPI for 2 weeks prior to testing

  • Use stool antigen or urea breath test

  • PHE: test after PPI trial due to low UK prevalence (<15%)

4️⃣ Treat if H. pylori Positive

  • Triple therapy: PPI + amoxicillin + clarithromycin/metronidazole (7 days)

  • Confirm eradication after 4 weeks

5️⃣ Ongoing Symptoms

  • Consider prolonged PPI or add H2RA

  • Refer for OGD if red flags or non-response

  • Manage autoimmune causes (e.g. B12 if needed)

  • Co-prescribe PPI with long-term NSAID use

⚠️Complications (Mnemonic: BAGS)

  • Bleeding – from erosive gastritis

  • Anaemia – iron or B12 deficiency

  • Gastric atrophy – in chronic autoimmune gastritis

  • Stomach cancer – associated with H. pylori and chronic inflammation

🔎 Autoimmune Gastritis

  • More common in older women

  • Associated with pernicious anaemia, thyroid disease, T1DM

  • Investigations: B12 level, anti-parietal cell and anti-intrinsic factor antibodies

  • Management: lifelong B12 injections if deficient

Last updated in line with NICE CKS: Dyspepsia – acute and chronic
Published: May 2010 • Last updated: April 2023
Last reviewed: July 2025
PASSMAP ensures all content is NICE-aligned and reviewed for Physician Associate Registration Assessment (PARA) success.

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