Gastritis

Gastritis is inflammation of the lining of the stomach. The lining normally protects itself from the acid it produces with a layer of mucus and a steady turnover of surface cells. When that defence is overwhelmed or worn down, the surface becomes inflamed, and in places it can erode.

Three causes account for most cases. A bacterium called Helicobacter pylori settles in the lining and keeps it inflamed for years; it is common in India and it is treatable. Regular painkillers of the anti-inflammatory kind, taken for joints, headaches or fever, block the chemicals the lining uses to protect itself. Alcohol strips the mucus layer directly. Bile flowing back from the intestine, severe illness, and an autoimmune process that attacks the lining account for most of the rest.

The distinction your doctor will be drawing is between a short-lived inflammation that settles once the cause is removed and a chronic one that has been quietly present for years. They are treated differently, and the second is the one worth finding.

Most of the diagnosis is made from what you say. Your doctor will want to know how long this has been going on, what makes it better and worse, what you have already taken for it and for how long, every painkiller and supplement you use including the ones bought without a prescription, how much alcohol you drink, and whether anyone in your family has had stomach trouble.

The examination is of your abdomen. Your doctor presses over the upper part to find where the tenderness sits and how deep it goes, checks that the liver and spleen are normal, and looks at your eyes and palms for the pallor that suggests slow blood loss. Your pulse and blood pressure are taken for the same reason.

They are also looking for the features that change the plan: losing weight without trying, food sticking on the way down, vomiting that will not stop, black stool, or an age and a family history that lower the threshold for investigating further. If any of those are present, or if treatment has already been tried and failed, your doctor will arrange a closer look and explain what the result would change.

Once the cause is removed, the lining repairs itself quickly. Acid-suppressing treatment usually settles the discomfort within a few days and is normally continued for four to eight weeks to let the surface heal properly. Stopping at the point you feel better is the commonest reason it returns a fortnight later.

Where Helicobacter pylori is found, the treatment is a fixed course of antibiotics with acid suppression, taken for one to two weeks. Every dose matters, because a partly taken course leaves a harder infection behind. Your doctor will arrange a test a month or more after the course finishes to confirm the bacterium has actually gone, and that test is the point of the treatment.

You can work throughout. What takes longer is the habit change the result depends on: finding a substitute for the anti-inflammatory painkillers if you take them regularly, cutting alcohol, eating at regular hours, and not lying down within a couple of hours of a meal.