What is Gastritis / Duodenitis?
Gastritis and duodenitis are both inflammatory conditions affecting different parts of the lining in your gastrointestinal tract which are common in Singapore— gastritis affects the stomach lining, while duodenitis affects a segment of the small intestine (duodenum, the part of the small intestine right after the stomach).
These conditions can occur in anyone and may be either acute or chronic. Gastritis and duodenitis generally do not cause serious side effects and are curable with lifestyle changes and medications.
Symptoms of Gastritis / Duodenitis
When people complain of having ‘gastric’ (tummy pain) after skipping lunch, it’s likely a manifestation of gastritis. Most have mild symptoms that are well-managed with antacids and eating regular meals. Some people do not have any symptoms, and may not even realise they have gastritis/duodenitis.
Common symptoms (if any), include:
- Early satiety (feeling full soon after eating)
- Burning sensation in the stomach
- Abdominal cramps
Causes of Gastritis / Duodenitis
By far, the most common cause of both of these conditions is Helicobacter pylori or H. pylori. It is a bacteria not native to the gastrointestinal tract, but it can easily colonise your gut and increase your risk of developing gastritis/duodenitis.
H. pylori has various sources such as food, water, or utensils, especially from places with poorer sanitation. The bacteria can also be spread via contact with the body fluids or saliva of infected people, who themselves may be unaware they are H. pylori carriers.
Some other non-bacterial causes of gastritis/duodenitis include:
- Long-term consumption of aspirin, NSAIDs (ibuprofen, naproxen)
- Excessive alcohol consumption
- Cigarette smoking
Avoiding the above causes can help reduce but not completely eliminate the risk of gastritis/duodenitis.
How is Gastritis / Duodenitis diagnosed?
Since these conditions are most commonly caused by H. pylori, the H. pylori breath test, also known as a urea breath test, can be used to ascertain the presence of this bacteria and confirm the likely diagnosis of gastritis/duodenitis.
The urea breath test works on the principle that H. pylori breaks down urea and generates carbon dioxide. Firstly, you will be asked to exhale into a bag and the carbon dioxide level will be measured.
Then, you will drink a liquid containing urea, and be asked to exhale into a bag after approximately 15 minutes. The amount of carbon dioxide measured after drinking the liquid will be compared to the initial value. If the second sample has more carbon dioxide than the first sample, you are H. pylori positive.
A gastroscopy may also be offered. It involves inserting a flexible, thin tube down one’s throat, with a camera attached to the end. This enables your doctor to visualise the appearance of your upper gastrointestinal tract (including the stomach and duodenum) and take samples of your tissue if required. Any inflammation, bleeding, or abnormal masses suggestive of an alternative diagnosis can be visualised, and biopsies (tissue samples) sent for testing if needed.
How is Gastritis / Duodenitis Treated?
Treatment for duodenitis depends on the cause.
For gastritis/duodenitis caused by H. pylori, the treatment is the eradication of the bacteria via triple therapy — a simple medication regimen of 1 proton pump inhibitor (PPI), with two antibiotics, taken for a total of 14 days. Your doctor will explain the exact medications and regime in greater detail as required.
As for other causes of gastritis/duodenitis, treatment includes stopping or reducing the intake of NSAIDs and alcohol. Smoking cessation and stress reduction will also help alleviate the symptoms of both conditions, as well as improve your overall health.
What complications can arise if I leave Gastritis / Duodenitis untreated?
If poorly controlled or left untreated, chronic inflammation can have various serious consequences.
- Bleeding of the lining/mucosa of the gastrointestinal tract — this may manifest as vomit with the appearance of either fresh blood or coffee grounds (digested blood), or passing blood in your stools (black, foul-smelling stools)
- Fever — constant inflammation can trigger your body’s immune response and cause a fever
- Weight loss and/or malnutrition — constant inflammation results in poorer digestion of food
- Stomach cancer — chronic inflammation puts one at a higher risk of stomach or duodenal cancer. An endoscopy may be required to assess for the presence of any malignancy
Generally, gastritis and duodenitis respond well to the treatment and lifestyle changes mentioned earlier. If you have any of the above symptoms or are concerned about cancer (especially if you have a family history of stomach cancer), do speak to a medical professional.
Is it just Gastritis/Duodenitis?
There are some other conditions that may cause similar symptoms and affect the gastrointestinal tract as well, such as peptic ulcers and oesophagitis.
Peptic Ulcers vs Gastritis/Duodenitis
Peptic ulcers include both gastric and duodenal ulcers, named after the sites they are located. Briefly, causes include excess stomach acid, H. pylori infections and some combinations of medications (which induce increased acidity).
Symptoms of these ulcers are fairly similar to that of gastritis duodenitis, such as burning gastric pain/cramps, feeling full, bloating or nausea. Additional symptoms more unique to peptic ulcers include intolerance to certain foods and pain related to the timing of food intake.
Proton pump inhibitors (PPI) are the first-line treatment for peptic ulcers. They are often prescribed for a few weeks and work by decreasing acidity, allowing the ulcers to have sufficient time to heal and relieve symptoms. Treatment for peptic ulcers caused by H.pylori involves the eradication of the bacteria, using the same triple therapy mentioned above for gastritis/duodenitis.
Oesophagitis vs Gastritis/Duodenitis
As the name suggests, oesophagitis is a condition in which the oesophagus (food tube) is inflamed. It comprises various inflammatory disorders with various causes, such as gastric reflux or eosinophilic, to name a few.
The main difference between oesophagitis and gastritis/duodenitis is simply the site of inflammation - the oesophagus is a part of the gastrointestinal tract directly above and connected to the stomach. The treatment for the various types of oesophagitis depends on the cause, which your doctor will advise you on.
What can I eat if I have Gastritis/Duodenitis?
The symptoms of gastritis/duodenitis can be worsened by the intake of certain foods or drinks that increase the acidity in your stomach/intestines or directly cause inflammation to their lining.
In general, one should reduce intake of, or avoid:
- Spicy foods
- Highly acidic foods such as citrus fruits, tomatoes, pineapples, etc.
- Fried or fatty foods
- Alcohol/caffeine-containing drinks
If you enjoy eating the above foods, they do not have to be eliminated from your diet entirely, but should be taken in reduced quantities or stopped if they worsen your symptoms.
On the other hand, some foods help alleviate the symptoms:
- Low-acidity foods
- Non-caffeinated & non-carbonated drinks
- High fibre foods
- Non-alcoholic beverages
Eating regular, small portions of food and leading a healthy, lower-stress lifestyle can prevent the worsening of gastritis as well.
In conclusion, gastritis, duodenitis, and other common inflammatory conditions of the gastrointestinal tract may be caused by a variety of reasons. Fortunately, there are various treatment options, both medical and lifestyle-related.
Dr Benjamin Yip reminds us that even though gastritis/duodenitis is benign, symptoms can be similar to gastric cancer, which is often lethal and can occur in individuals in their 30’s or 40’s. If in doubt, speak to your Gastroenterologist today!
- “Helicobacter pylori and Gastric Cancer: Factors That Modulate Disease Risk.” NCBI, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2952980/. Accessed 4 October 2022.
- “Helicobacter pylori infection: old and new - PMC.” NCBI, 4 June 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5467250/. Accessed 4 October 2022.
- Kuipers, Ernst J. “PPIs for prevention and treatment of peptic ulcer.” The Lancet: Gastroenterology & Hepatology, https://www.thelancet.com/journals/langas/article/PIIS2468-1253(18)30047-5/fulltext. Accessed 4 october 2022.
- Li, Yan. “What Roles Do Probiotics Play in the Eradication of Helicobacter pylori? Current Knowledge and Ongoing Research.” NCBI, 16 October 2018, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6206577/. Accessed 4 October 2022.
- “Stress-Induced Gastritis - StatPearls.” NCBI, 1 May 2022, https://www.ncbi.nlm.nih.gov/books/NBK499926/. Accessed 4 October 2022.