Atrophic Gastritis

Atrophic gastritis is a chronic condition where the lining of your stomach becomes inflamed and thins over time. This inflammation damages the glands in your stomach that produce acid and other important substances, including a protein needed to absorb vitamin B12. It can lead to digestive issues and nutrient deficiencies.

What is Atrophic Gastritis?

Atrophic gastritis is a long-lasting condition characterized by ongoing inflammation that gradually damages and thins the inner lining of your stomach. This damage causes a loss of the specialized glands that normally produce stomach acid and a protein called intrinsic factor, which is essential for absorbing vitamin B12. Over time, the stomach lining can change, potentially leading to other health issues.

Your stomach lining contains different types of glands that play vital roles in digestion. Some glands produce stomach acid, which helps break down food and kill bacteria. Other glands produce intrinsic factor, a protein that binds to vitamin B12 so your body can absorb it in the small intestine. In atrophic gastritis, these glands are progressively destroyed and replaced by different types of cells, a process called metaplasia. This change means your stomach produces less acid and less intrinsic factor. The reduced acid can affect digestion and allow certain bacteria to thrive, while the lack of intrinsic factor leads to difficulties absorbing vitamin B12.

Symptoms

Many people with atrophic gastritis experience no symptoms, especially in the early stages. When symptoms do occur, they are often related to a deficiency of vitamin B12, which happens because the damaged stomach lining cannot produce enough intrinsic factor to absorb this vital nutrient. These symptoms can develop slowly over time.

Symptoms related to vitamin B12 deficiency, also known as pernicious anemia, can include feeling very tired and weak (fatigue), lightheadedness, and shortness of breath. You might also notice your skin looking paler than usual. As the B12 deficiency progresses, it can affect your nervous system. This might cause tingling or numbness in your hands and feet, problems with balance, difficulty walking, and even memory issues or confusion. Other less common symptoms can include an upset stomach, indigestion, or a feeling of fullness after eating small amounts of food.

Causes & risk factors

The two main causes of atrophic gastritis are a bacterial infection called Helicobacter pylori (H. pylori) and an autoimmune reaction where your body's immune system mistakenly attacks its own stomach cells. Certain factors can increase your risk of developing this condition, including age and other autoimmune diseases.

The most common cause worldwide is a long-term infection with the bacterium H. pylori. This bacterium can live in your stomach lining for many years, causing chronic inflammation that eventually leads to the destruction of the stomach glands. This type is often called environmental atrophic gastritis. The second major cause is autoimmune atrophic gastritis. In this condition, your immune system produces antibodies that attack the parietal cells in your stomach. These cells are responsible for producing stomach acid and intrinsic factor. People with other autoimmune diseases, such as Hashimoto's thyroiditis or type 1 diabetes, may have a higher risk of developing autoimmune atrophic gastritis. The risk also tends to increase with age.

How it's diagnosed

Diagnosing atrophic gastritis typically involves a combination of tests, including blood tests and an endoscopy with a biopsy. These tests help your doctor confirm the presence of inflammation, assess the extent of damage to your stomach lining, and identify the underlying cause, such as H. pylori infection or autoimmune factors.

Your doctor will likely start with blood tests. These can check for signs of anemia, particularly low levels of vitamin B12. They might also look for specific antibodies, such as parietal cell antibodies or intrinsic factor antibodies, which are often present in autoimmune atrophic gastritis. Levels of gastrin, a hormone that stimulates acid production, might also be measured. The most definitive way to diagnose atrophic gastritis is through an upper endoscopy. During this procedure, a thin, flexible tube with a camera is passed down your throat into your esophagus, stomach, and the beginning of your small intestine. Your doctor will examine the stomach lining and take small tissue samples (biopsies) from different areas. These samples are then examined under a microscope to confirm the presence of atrophic changes and identify any H. pylori infection.

Treatment options

Treatment for atrophic gastritis focuses on addressing the underlying cause and managing any complications, particularly vitamin B12 deficiency. If an H. pylori infection is present, antibiotics are used to eradicate the bacteria. For B12 deficiency, lifelong supplementation is usually necessary to prevent serious health problems.

If H. pylori infection is identified as the cause, your doctor will prescribe a course of antibiotics, often combined with a proton pump inhibitor (a medication that reduces stomach acid), to eliminate the bacteria. Eradicating H. pylori can help stop the progression of inflammation and may, in some cases, allow the stomach lining to partially recover. For vitamin B12 deficiency, which is common in both types of atrophic gastritis, treatment involves supplementing B12. This is often given through injections initially, especially if symptoms are severe, because the damaged stomach lining cannot absorb B12 from oral supplements effectively. Once levels are stable, some people may be able to switch to high-dose oral B12 supplements, nasal gels, or sublingual (under the tongue) forms, but many require ongoing injections. This supplementation is usually lifelong.

Recovery & outlook

Atrophic gastritis is generally a chronic condition, meaning it is long-lasting and often requires ongoing management. While the damage to the stomach lining may not fully reverse, treating the underlying cause and managing vitamin B12 deficiency can prevent further progression and improve your quality of life. Regular monitoring is important due to potential long-term risks.

With appropriate treatment, especially B12 supplementation, people with atrophic gastritis can live full and healthy lives. The symptoms related to B12 deficiency, such as fatigue and neurological issues, typically improve significantly once B12 levels are restored and maintained. It is crucial to adhere to the prescribed B12 regimen, as stopping it can lead to a recurrence of symptoms and further health complications. Because atrophic gastritis involves changes to the stomach lining, there is a slightly increased risk of developing certain conditions, including stomach polyps and, in rare cases, stomach cancer. For this reason, your doctor may recommend periodic endoscopic surveillance to monitor the stomach lining for any concerning changes. The frequency of these check-ups will depend on individual risk factors and the specific findings from your biopsies.

When to see a doctor

You should see your doctor if you experience persistent digestive symptoms, such as ongoing stomach pain, nausea, or unexplained weight loss. It is especially important to seek medical attention if you notice symptoms of vitamin B12 deficiency, like extreme fatigue, weakness, tingling in your hands or feet, or problems with balance and memory, as these can indicate atrophic gastritis or another serious condition.

Do not delay seeing a healthcare professional if you have any of the following: severe or worsening abdominal pain, persistent vomiting, blood in your vomit or stool (which may appear black and tarry), or difficulty swallowing. These could be signs of more serious complications. If you have a family history of atrophic gastritis, pernicious anemia, or stomach cancer, or if you have an autoimmune disease, discuss these concerns with your doctor. They can help determine if you should be screened for atrophic gastritis or monitored more closely, even if you don't have obvious symptoms.

Frequently asked questions

Can atrophic gastritis be cured?

Atrophic gastritis is generally a chronic condition. While treating the underlying cause, like eradicating H. pylori, can stop its progression, the damage to the stomach lining may not fully reverse. Lifelong management, especially for vitamin B12 deficiency, is often needed.

Is atrophic gastritis serious?

Yes, it can be serious if left untreated. It can lead to severe vitamin B12 deficiency (pernicious anemia) with neurological damage. It also carries a slightly increased, though still small, risk of developing stomach cancer over time, requiring regular monitoring.

What foods should I avoid with atrophic gastritis?

There isn't a specific diet for atrophic gastritis itself. However, if you experience digestive discomfort, avoiding foods that trigger your symptoms, such as spicy, fatty, or acidic foods, may be helpful. Focus on a balanced, nutritious diet.

How often do I need B12 injections for atrophic gastritis?

The frequency of B12 injections varies. Initially, they might be given more often (e.g., weekly) to restore levels. Once stable, injections are typically given monthly for life. Your doctor will determine the best schedule for you.

Can atrophic gastritis cause weight loss?

Unexplained weight loss can be a symptom of various digestive issues, including atrophic gastritis, especially if it leads to nutrient malabsorption or severe digestive discomfort. If you experience unintentional weight loss, consult your doctor.

Is atrophic gastritis hereditary?

While atrophic gastritis itself isn't directly inherited, there can be a genetic predisposition, especially for the autoimmune type. If close family members have autoimmune diseases or pernicious anemia, your risk might be higher.

Sources

• MedlinePlus — Atrophic Gastritis
• Mayo Clinic — Atrophic Gastritis
• Cochrane Library — Atrophic Gastritis