Symptoms

Initially, chronic gastritis often causes no symptoms.This is because it develops slowly over several years. Therefore, the disease often goes unnoticed for a long period of time. At best, a feeling of fullness or flatulence may occasionally occur, which is not usually immediately associated with inflammation of the stomach lining.

When symptoms occur, they are often similar to the symptoms of acute gastritis. Non-specific complaints in the upper abdomen occur, such as an increased feeling of pressure or pain. The flatulence can increase and diarrhoea can also occur.

Heartburn, nausea and vomiting are also possible symptoms. Bad breath also indicates that there is something wrong with the stomach. This occurs mainly with type B gastritis.

In very advanced stages, blood may be present in the stool, which can be recognized by so-called tarry stools, i.e. black-colored stools. The vomiting of light-colored blood can also indicate an inflammation of the gastric mucosa with severe injuries to the mucous membrane, but is rather rare. Depending on the type of chronic gastritis, the symptoms can vary.

In type A gastritis, the symptoms of pernicious anemia can occur in addition to the typical stomach complaints. These include fatigue, reduced performance, yellowing of the skin and, as the disease progresses, neurological deficits. Type C gastritis usually causes very unspecific symptoms, which could also indicate an irritable stomach.

If peptic ulcers have already developed in the course of chronic gastritis, they can manifest themselves as cramp-like, stabbing pain in the upper abdomen. This pain usually occurs after eating. Diarrhea is one of the symptoms that occur in both chronic and acute gastritis.

In the case of chronic gastritis, symptoms usually only appear later in the course of the disease. The inflammation of the stomach mucosa gradually sets in and diarrhoea and other symptoms only occur when the mucosa already shows considerable damage. As a rule, the diarrhea is watery.

Classification

The classification of chronic gastritis is based on the cause and is divided into three forms:

Chronic gastritis type A
Chronic gastritis type B
Chronic gastritis type C

Chronic gastritis type A is also known as autoimmune gastritis. This means that it is triggered by antibodies produced by the body itself. This form of chronic gastritis is the rarest and accounts for about 5% of all gastritides.

It can be hereditary and is more common in people who already suffer from other autoimmune diseases such as diabetes mellitus type I, Addison’s disease or Hashimoto’s thyroiditis. The autoantibodies that the body produces in type A gastritis are directed against the so-called parietal cells of the stomach. These are normally responsible for the production of gastric acid.

Their destruction leads to a deficiency. As a result of the reduced secretion, the hormone gastrin is released, which is supposed to stimulate the production of gastric acid. However, since the cells in the vial no longer function properly, gastrin secretion does not help with acid secretion.

Instead, it promotes the development of stomach tumors. The gastrointestinal cells also produce intrinsic factor, which enables the absorption of vitamin B12 from the intestine. Due to the destruction of the parietal cells, there is therefore also a deficiency of intrinsic factor.

This results in vitamin B12 anemia (pernicious anemia), since vitamin B12 is needed for the production of blood pigment. Chronic gastritis of the type B gastric mucosa represents the largest proportion of gastritides with about 80%. It is caused by bacteria of the genus Helicobacter pylori.

These are spiral-shaped bacteria that can survive in the acidic environment of the stomach by neutralizing it and settling there. Through the production of various enzymes, the stomach lining is damaged. This type of gastritis mainly damages the area of the stomach at the transition to the stomach outlet.

Helicobacter pylori can survive unnoticed in the stomach for years. Due to the damage to the mucous membrane, the risk of developing gastric cancer is increased. The bacterium can be transmitted by stool or spit.Chronic type C gastritis is caused by chemical irritation of the stomach.

These include bile and certain painkillers from the group of non-steroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen®, Diclofenac® or acetylsalicylic acid (ASS, Aspirin®). These drugs attack the protective layer of the stomach, especially when taken over a longer period of time, and thus lead to damage of the stomach lining. This can lead to chronic gastritis type C. Normally, the bile is conducted into a part of the small intestine, the duodenum, where it is needed for digestion.

However, if the bile flows back into the stomach (bile reflux), the acidic stomach environment is disturbed and this can lead to damage to the mucous membranes. This can result in chronic gastritis. This is often the case after operations on the stomach area. Type C gastritis accounts for about 10 to 15% of chronic gastritis.