My Endoscopy Report Says Gastritis: What Does It Mean?

Seeing “gastritis”, “antral gastritis”, “pangastritis”, “erythematous gastritis” or “erosive gastritis” on a gastroscopy report is quite common.

Gastritis generally means inflammation of the stomach lining. But in everyday use, and in some endoscopy reports, changes seen on the stomach’s surface such as redness, swelling or erosion may also be described as “gastritis”.

So there is an important distinction here:

The “appearance of gastritis” at endoscopy and the “histological gastritis” shown on a biopsy are not always the same thing. A gastroscopy assesses how the surface of the stomach looks; a biopsy assesses the features of the tissue taken, under the microscope.

What is gastritis?

The inner surface of the stomach is covered by a protective layer called the mucosa. Inflammation developing in this tissue is called gastritis.

Gastritis can be:

• Acute or chronic
• In one particular part of the stomach or throughout it
• Mild or more marked

Determining the cause of the gastritis also matters.

How does gastritis look at endoscopy?

During a gastroscopy the doctor may notice changes in the stomach lining such as:

• Redness
• Swelling
• Fragility
• Small superficial erosions
• A nodular appearance
• Thinning of the mucosa
• Blood vessels showing more clearly

Reports may use different phrases accordingly.

What does “antral gastritis” mean?

The antrum is the lower part of the stomach, near its outlet. “Antral gastritis” on an endoscopy report means that changes consistent with gastritis are seen particularly in this region.

One of the causes of antral gastritis is Helicobacter pylori (H. pylori) infection. But antral gastritis does not mean H. pylori is present. Whether H. pylori is there is investigated with appropriate tests.

What does “pangastritis” mean?

The word pan means “all”. Pangastritis means that changes consistent with gastritis are found not in one region only but more widely across the stomach lining.

The word pangastritis does not mean the condition must be severe. Extent and severity are different things.

What does “erosive gastritis” mean?

An erosion is superficial damage to the stomach lining. In erosive gastritis small superficial defects can be seen on the stomach’s surface. Causes can include:

• NSAID painkillers
• Alcohol
• Some medicines
• Severe systemic illness
• Other factors affecting the mucosa

An erosion and an ulcer are not the same thing. An ulcer is a deeper loss of tissue in the mucosa.

Does Helicobacter pylori cause gastritis?

Yes. H. pylori is one of the most important causes of chronic gastritis. The infection can continue for years without symptoms.

H. pylori can be associated with:

• Chronic gastritis
• Peptic ulcer
• Atrophic gastritis
• Intestinal metaplasia

Long-standing infection can also increase the risk of stomach cancer and gastric MALT lymphoma in some people.

But this does not mean everyone carrying H. pylori will develop an ulcer or cancer.

Why is a biopsy taken in gastritis?

When gastritis is seen during a gastroscopy, the doctor may take small tissue samples from the stomach if they think it necessary. A biopsy may be taken to:

• Look for H. pylori
• Assess the microscopic features of the gastritis
• Determine whether there is atrophy
• Look for intestinal metaplasia
• Examine a suspicious area

Can the report say gastritis while the biopsy is normal?

Yes. Despite redness or other surface changes at endoscopy, a biopsy may show no marked inflammation.

The opposite is possible too: the stomach can look quite normal at endoscopy while the biopsy shows chronic gastritis or H. pylori.

So endoscopy gives the appearance and biopsy gives the microscopic assessment. The two complement each other.

Is gastritis cancer?

No. Gastritis is not cancer. Interpreting a simple diagnosis of gastritis as “cancer is starting in my stomach” is not correct.

But the type and cause of the gastritis matter. Atrophic gastritis, intestinal metaplasia and some H. pylori-related changes in particular are situations that need assessing separately.

Finding these does not mean the person has cancer either; in some patients they can affect future risk and the approach to follow-up.

Is atrophic gastritis different from ordinary gastritis?

Yes. In atrophic gastritis there is a loss of glands in the stomach lining. H. pylori-related chronic gastritis or autoimmune gastritis can be among the causes.

Atrophic gastritis can be associated with:

• B12 deficiency
• Iron deficiency
• Intestinal metaplasia
• An increase in the risk of some stomach tumours

So a report saying simply “gastritis” and one saying “atrophic gastritis” should not be judged the same way.

What does intestinal metaplasia mean?

Intestinal metaplasia is a change in which the cells of the stomach lining take on features resembling those of intestinal cells. It is usually found on biopsy.

Intestinal metaplasia is not cancer. But it is regarded as a pre-cancerous change in the lining that matters in assessing the risk of stomach cancer in some people. Its extent, any accompanying atrophy, H. pylori status and other risk factors matter in the decision about follow-up.

Is gastritis the same as reflux?

No. Gastritis describes the stomach lining, while gastro-oesophageal reflux describes stomach contents flowing back into the oesophagus. Both can be present in one person, but they are not the same condition.

Does gastritis cause stomach pain?

It can. Some people have pain or discomfort in the upper abdomen, burning, nausea, bloating, early fullness and indigestion.

But there is an important point here: seeing gastritis at endoscopy does not mean all of a patient’s symptoms must come from the gastritis. Similar symptoms can be seen in other conditions too, including functional dyspepsia, reflux, ulcers, and diseases of the bile ducts or pancreas.

How is gastritis treated?

Treatment varies with the cause of the gastritis. For example:

• If H. pylori is present Appropriate eradication treatment can be planned.
• If it is medicine-related The medicines being taken are assessed.
• If there is erosive gastritis The cause of the mucosal damage and the risk of bleeding are assessed.
• If there is autoimmune gastritis Related conditions such as B12 and iron deficiency may be investigated.
• If there are acid-related symptoms Acid-suppressing treatment may be used in suitable patients.

So the approach “there is gastritis → the same stomach medicine for everyone” is not correct.

Is a diet needed for gastritis?

There is no strict “gastritis diet” that applies to everyone. Cutting down on foods and drinks that clearly make a person’s symptoms worse can help.

Excess alcohol, very fatty or spicy foods that cause a person discomfort, and large amounts of coffee or caffeine can make symptoms worse in some people.

But cutting a great many foods out of the diet unnecessarily is not right.

Does coffee cause gastritis?

Coffee can make stomach symptoms worse in some people. But a diagnosis of gastritis cannot be made from coffee consumption alone. Whether coffee causes discomfort varies from person to person.

Does smoking matter?

Smoking has various harmful effects on the digestive system and can hinder healing in peptic ulcer disease in particular. Giving it up is therefore beneficial for the stomach as it is for general health.

Does gastritis go away completely?

That depends on its cause.

When H. pylori is successfully treated, for instance, the inflammation can lessen over time. But chronic structural changes such as atrophy or intestinal metaplasia are assessed differently.

So rather than asking only “has the gastritis gone?”, what matters is knowing the cause and type of the gastritis.

Is a repeat endoscopy needed?

A follow-up endoscopy is not needed after every diagnosis of gastritis. The decision to repeat a gastroscopy is made according to features such as:

• The biopsy result
• H. pylori status
• Atrophy or intestinal metaplasia
• The presence of an ulcer
• The patient’s age and risk factors
• Continuing or newly developed alarm symptoms

With which symptoms should assessment not be delayed?

What should you do if your report says “gastritis”?

1. Do not panic. Gastritis does not mean cancer.
2. Look at where and how the gastritis is described. Antral, pangastritis, erosive and atrophic are not the same.
3. If a biopsy was taken, be sure to review the pathology result.
4. Look at the H. pylori result.
5. Review the medicines you take. Some painkillers matter in particular.
6. Do not put alarm symptoms down to gastritis.
7. Plan treatment according to the cause of the gastritis.

Remember

• GASTRITIS Is not cancer.
• H. PYLORI Is one of the important causes of chronic gastritis.
• A BIOPSY BEING TAKEN Does not mean cancer was suspected.
• AN EROSION Is not the same thing as an ulcer.
• ATROPHY / INTESTINAL METAPLASIA Are assessed differently from simple gastritis.
• ENDOSCOPY Assesses how the stomach looks.