History and exam

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MaagklachtenPublished by: NHGLast published: 2025

Key diagnostic factors

common

presence of risk factors

Key risk factors include Helicobacter pylori infection, non-steroidal anti-inflammatory drug use, alcohol use/toxic ingestions, prior gastric surgery, critically ill patients, and autoimmune disease.[2][3]​​​[4][5][6][8][9][17][18]​​

dyspepsia/epigastric discomfort

Non-specific symptom of gastritis.[2][40]

no suspicious features of malignancy

Suspicious features include gastrointestinal (GI) bleeding, anaemia, early satiety, unexplained weight loss (>10% body weight), progressive dysphagia, odynophagia, or persistent vomiting.[3]​​[41]

If present, they suggest GI malignancy rather than gastritis.

The risk of having malignancy is considered to be very low in people aged <60 years.[40]

Other diagnostic factors

common

nausea, vomiting, and loss of appetite

Non-specific GI symptoms of gastritis include nausea, vomiting, and loss of appetite.[40]

uncommon

severe emesis

Symptom of phlegmonous gastritis.[10][11][12][13]

acute abdominal pain

Symptom of phlegmonous gastritis.[10][11][12][13]

fever

Symptom of phlegmonous gastritis.[10][11][12][13]

altered reflexes or sensory deficits

Patients may have signs and symptoms consistent with clinical vitamin B12 deficiency and pernicious anaemia due to chronic gastric inflammation and mucosal atrophy in older people, or autoimmune atrophic gastritis.[2][29][31]

cognitive impairment

Patients may have signs and symptoms consistent with clinical vitamin B12 deficiency and pernicious anaemia due to gastric mucosal atrophy.[2][29][31]

glossitis

Patients may have signs and symptoms consistent with clinical vitamin B12 deficiency due to chronic gastric atrophy, or the 'fiery red tongue' associated with pernicious anaemia.[2][29][31]

co-existing autoimmune disease

Patients with autoimmune gastritis may have manifestations of associated autoimmune disease (e.g., thyroid disease, idiopathic adrenocortical insufficiency, vitiligo, type 1 diabetes mellitus, and hypoparathyroidism).[20][31]

Risk factors

strong

Helicobacter pylori infection

H pylori infection may cause both an acute and chronic gastritis.[3]​ H pylori is transmitted primarily by the faecal-oral route, but transmission is also possible via the oral-oral route.[22]

Chronic infection with H pylori predisposes to atrophic gastritis and autoimmune gastritis.

H pylori infection induces a severe inflammatory response with gastric mucin degradation and increased mucosal permeability that are directly cytotoxic to the gastric epithelium.[2][34]​​

non-steroidal anti-inflammatory drug (NSAID) use

Up to 10% to 20% of patients taking NSAIDs report symptoms of dyspepsia, although the prevalence may range from 5% to 50%.[17][18]

Factors identified as placing patients at increased risk for NSAID-related gastrointestinal (GI) complications include prior history of a GI event (peptic ulcer, haemorrhage), age >60 years, high dosage of NSAIDs, and concurrent use of corticosteroids or anticoagulants.[27][28]

NSAIDs inhibit prostaglandin production. This in turn decreases gastric mucosal blood flow with loss of the mucosal protective barrier.[2] NSAIDs inhibit prostaglandin production.

alcohol use/toxic ingestions

Alcohol is recognised as a risk factor for erosive gastritis. Alcohol promotes depletion of sulfhydryl compounds in gastric mucosa.[2][26] Phlegmonous gastritis is also associated with recent intake of large quantities of alcohol.[33]

Emphysematous gastritis, a rare infection of the stomach wall caused by gas-producing organisms, has been associated with ingestion of corrosive agents.[35]

previous gastric surgery

Previous gastric surgery (e.g., gastroduodenal or gastrojejunal anastomosis, truncal vagotomy, and pyloroplasty) or cholecystectomy may alter or impair pyloric function leading to bile regurgitation and bile-reflux gastritis.[4][5][6][7]

critically ill patients

Critically ill patients are at risk of developing stress-induced gastrointestinal bleeding.[8] The mechanism is unclear but involves decreased mucosal blood flow and loss of the mucosal protective barrier.[2] The main risk factors associated with clinically important haemorrhage are mechanical ventilation for >48 hours and the presence of a coagulopathy.[8]

autoimmune disease

Autoimmune disorders associated with increased risk of autoimmune gastritis include thyroid disease, idiopathic adrenocortical insufficiency, vitiligo, type 1 diabetes mellitus, and hypoparathyroidism.[20][29]

weak

immunocompromise

Phlegmonous gastritis is associated with HIV infection and other immunocompromised states.[36] 

infected peritoneojugular venous shunt

An infected peritoneojugular venous shunt may result into phlegmonous gastritis.[37]

North European or Scandinavian ancestry

Recognised risk factor for autoimmune gastritis and pernicious anaemia due to vitamin B12 malabsorption.[9]

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