Gastritis

Also indexed as: Stomach Inflammation

Gastritis is a broad term for inflammation of the stomach lining, also called the gastric mucosa. This condition can be caused by many factors and, in some cases, may lead to an ulcer. For that reason, many of the same nutrients, herbs, and lifestyle changes for a peptic ulcer might also help someone with gastritis.

Bacterial infection, most notably with Helicobacter pylori, 1 is a major cause of gastritis. H. pylori is the same bacterium responsible for most cases of peptic ulcer. When considering treatments for gastritis, many researchers now look for substances that eradicate H. pylori, including bismuth 2 and antibiotics.3

Other causes of gastritis include intake of caustic poisons, alcohol, and some medications (such as aspirin or steroids), as well as physical stress from the flu, major surgery, severe burns, or injuries. For some people, a drug allergy or food poisoning can cause gastritis. Atrophic gastritis is a form of gastritis found particularly in the elderly, where stomach cells are destroyed, potentially leading to pernicious anemia.

Checklist for Gastritis

Rating Nutritional Supplements Herbs
2Stars Gamma oryzanol
N-acetyl cysteine
Vitamin C		  
1Star Arginine
Beta-carotene
Glutamine
Vitamin A
Zinc		 Chamomile
Goldenseal
Licorice
Marshmallow
Slippery elm
Wood betony
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

What are the symptoms of gastritis? Acute gastritis is typically characterized by nonspecific abdominal pain. Since gastritis often occurs in severely ill, hospitalized people, its symptoms may be eclipsed by other, more severe symptoms. Gastritis that is caused by H. pylori eventually leads to peptic ulcers, which are characterized by a dull ache in the upper abdomen that usually occurs two to three hours after a meal; the ache is typically relieved by eating.

How is it treated? Acute gastritis caused by trauma, stress, or severe illness usually resolves spontaneously when the stress or underlying cause is resolved. Peptic ulcers are normally treated with antibiotics to eliminate infection with H. pylori. In addition, other medications may be prescribed to control stomach acidity, including histamine H2 inhibitors, proton pump inhibitors, and antacids.

Dietary changes that may be helpful: Salt can irritate the stomach lining. Some research suggests that eating salty foods increases the risk of developing a H. pylori infection.4 Researchers have speculated that increased salt intake may also increase the risk of other forms of gastritis.5

Doctors commonly suggest that people with gastritis avoid spicy foods. However, one study found that capsaicin, the pungent ingredient in cayenne or chili pepper, protected against aspirin-induced gastritis in healthy persons. When people ate chili pepper followed by 600 mg of aspirin, stomach injury was considerably less than in people who took only aspirin.6 The researchers of this study speculate that chili pepper helps by increasing blood flow to the stomach. Capsaicin has also been shown to protect against alcohol-induced gastritis in rats,7 though this has yet to be tested in humans.

Some researchers have suggested that food allergies or intolerance may cause gastritis.8 In one double-blind trial, people with proven food sensitivities showed clear evidence of irritation of the stomach lining (including swelling, bleeding, and erosions) when given foods to which they were known to react.9 However, most of these people did not have abnormal results from standard blood tests for allergies. People suspecting food sensitivities or allergies should consider discussing an allergy elimination program with a healthcare professional.

Caffeine found in coffee, black tea, green tea, some soft drinks, chocolate, and many medications increases stomach acid,10 as does decaffeinated coffee.11 Avoiding these substances should therefore aid in the healing of gastritis.

Lifestyle changes that may be helpful: Gastritis is common among alcoholics.12 Both heavy smoking and excessive alcohol consumption are known causes of acute gastritis.13 While heavy alcohol intake is clearly damaging to the stomach lining, preliminary evidence suggests that moderate alcohol consumption (generally defined as two drinks per day in women or three drinks per day in men) may actually protect against the development of gastritis by facilitating the elimination of H. pylori.14 When alcohol is consumed in greater than moderate amounts, it causes a wide variety of health problems.

Many medications, such as aspirin and non-steroidal anti-inflammatory drugs (NSAIDS, such as ibuprofen), can induce or aggravate stomach irritation.15 People with a history of gastritis should never take aspirin or related drugs without first discussing the matter with their doctor.

Nutritional supplements that may be helpful: When H. pylori causes gastritis, free radical levels rise in the stomach lining.16 These unstable molecules contribute to inflammation and damage to the stomach lining. Vitamin C, an antioxidant that helps quench free radical molecules, is low in the stomach juice of people with chronic gastritis. This deficiency may be the link between chronic gastritis and the increased risk of stomach cancer. When people with gastritis took 500 mg of vitamin C twice a day, vitamin C levels in their gastric juice rose, though not to normal levels.17 In another trial, vitamin C supplementation (5 grams per day divided into several doses for four weeks) appeared to eliminate H. pylori infection.18 While no direct evidence proves that taking vitamin C reduces gastritis symptoms, scientists widely believe that any agent capable of knocking out H. pylori should help people with this condition.

The results of several clinical trials suggest that gamma oryzanol supplementation can help people with gastritis and other gastrointestinal complaints. In one study, people with chronic gastritis were given 300 mg of gamma oryzanol per day.19 After two weeks, 23% of people taking gamma oryzanol reported that it was “extremely effective” and 55% rated it as “moderately effective.” Another study produced similar results: People with various types of gastritis received 300 mg of gamma oryzanol per day. After two weeks, more than 62% of those with superficial gastritis, more than 87% of those with atrophic gastritis, and all people with erosive gastritis experienced improvement. These results were confirmed in a large study involving approximately 2,000 people with various gastrointestinal complaints, including several forms of gastritis.20 Some of these people required as much as 600 mg per day for symptoms to improve. People with gastritis wishing to take gamma oryzanol for more than six months, or in amounts exceeding 300 mg per day, should first consult with a physician.

Various amino acids have shown promise for people with gastritis. In a double-blind trial, taking 200 mg of cysteine four times daily provided significant benefit for people with bleeding gastritis caused by NSAIDs (such as aspirin).21 Cysteine is a sulfur-containing amino acid that stimulates healing of gastritis. In a preliminary trial, 1–4 grams per day of N-acetyl cysteine given to people with atrophic gastritis for four weeks appeared to increase healing.22 Glutamine, another amino acid is a main energy source for cells in the stomach and supplementation may increase blood flow to this region.23 Patients in surgical intensive care units often develop gastrointestinal problems related to a glutamine deficiency.24 When burn victims were supplemented with glutamine, they did not develop stress ulcers, even after several operations.25 Nevertheless, it remains unclear to what extent glutamine supplementation might prevent or help existing gastritis. Preliminary evidence suggests the amino acid arginine may both protect the stomach and increase its blood flow,26 but research has yet to investigate the effects of arginine supplementation in people with gastritis.

The antioxidant beta-carotene may reduce free radical damage in the stomach,27 and eating foods high in beta-carotene has been linked to a decreased risk of developing chronic atrophic gastritis.28 Moreover, people with active gastritis have been reported to have low levels of beta-carotene in their stomachs.29 In a preliminary trial, giving 30,000 IU of beta-carotene per day to people with ulcers or gastritis led to the disappearance of gastric erosions.30 In another study, combining vitamin C and beta-carotene also led to improvement in most people with chronic atrophic gastritis.31

Zinc and vitamin A, nutrients that aid in healing, are commonly used to help people with peptic ulcers. For example, the ulcers of people taking 50 mg of zinc three times per day healed three times faster than those of people who took placebo.32 Since some types of gastritis can progress to peptic ulcer, it is possible that taking it may be useful. Nevertheless, the research does not yet show that zinc specifically helps people with gastritis. The amount of zinc used in this study is very high compared with what most people take (15–40 mg per day). Even at these lower levels, it is necessary to take 1–3 mg of copper per day to avoid a zinc-induced copper deficiency.

People with ulcers who took 50,000 IU of vitamin A three times a day experienced a significant decrease in both ulcer size and pain.33 Because this amount of vitamin A is very high and can be quite toxic, usage requires the guidance of a doctor. A safe amount for women of childbearing age is 10,000 IU per day and probably 25,000 IU for other adults. In other preliminary research, using vitamin A together with drugs and proper nutrition eliminated erosive gastritis after three weeks in about 75% of affected people.34 Research has not yet shown that vitamin A supplementation specifically helps people with gastritis.

People with pernicious anemia due to atrophic gastritis require very high amounts of vitamin B12.

Are there any side effects or interactions? Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful: Many of the same herbs that are helpful for peptic ulcers may also aid people with gastritis. Licorice root, for example, has been traditionally used to soothe inflammation and injury in the stomach. Its flavonoid constituents have been found to stall the growth of H. pylori in test tube studies.35 However, there have been no clinical trials using licorice to treat gastritis. To avoid potential side effects, such as increasing blood pressure and water weight gain, many physicians recommend deglycyrrhizinated licorice (DGL). This form of licorice retains its healing qualities by removing the glycyrrhizin that causes problems in some people.

Goldenseal is regarded as an herbal antibiotic and has been traditionally used for infections of the mucous membranes. While no specific research points to goldenseal as a treatment for gastritis, there is some evidence from test tube studies that berberine, an active ingredient in goldenseal, slows growth of H. pylori. 36 Modern herbal practitioners now prefer alternatives to goldenseal, since the plant is threatened with extinction due to overharvesting.

Chamomile, high in the flavonoid apigenin, may soothe injured and inflamed mucous membranes. In addition, a test tube study has shown that apigenin inhibits H. pylori, 37 and chamazulene, another active ingredient in chamomile, reduces free radical activity,38 both potential advantages for people with gastritis. Human clinical trials are needed to confirm chamomile’s effectiveness for treating gastritis.

Demulcent herbs, such as marshmallow, slippery elm, and bladderwrack, are high in mucilage. Mucilage might be advantageous for people with gastritis because its slippery nature soothes irritated mucus membranes of the digestive tract. Marshmallow is used for mild inflammation of the gastric mucosa.39

Wood betony (Stachys betonica) has been used in European traditional herbal medicine for the treatment of heartburn and gastritis.

Are there any side effects or interactions? Refer to the individual herb for information about any side effects or interactions.

References:

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2. Kumar M, Yachha SK, Aggarwal R, et al. Healing of chronic antral gastritis: effect of sucralfate and colloidal bismuth subcitrate. Indian J Gastroenterol 1996;15(3):90–3.

3. Lieber CS. Gastric ethanol metabolism and gastritis: interactions with other drugs, Helicobacter pylori, and antibiotic therapy (1957–1997)--a review. Alcohol Clin Exp Res 1997;21:1360–6 [review].

4. Tsugane S, Tei Y, Takahashi T, et al. Salty food intake and risk of Helicobacter pylori infection. Jpn J Cancer Res 1994;85(5):474–8.

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6. Yeoh KG, Kang JY, Yap I, et al. Chili protects against aspirin-induced gastroduodenal mucosal injury in humans. Dig Dis Sci 1995;40(3):580–3.

7. Yeoh KG, Kang JY, Yap I, et al. Chili protects against aspirin-induced gastroduodenal mucosal injury in humans. Dig Dis Sci 1995;40(3):580–3.

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11. Elta GH, Behler EM, Colturi TJ. Comparison of coffee intake and coffee-induced symptoms in patients with duodenal ulcer, nonulcer dyspepsia, and normal controls. Am J Gastroenterol 1990;85(10):1339–42.

12. Altman C, Ladouch A, Briantais MJ, et al. Antral gastritis in chronic alcoholism. Role of cirrhosis and Helicobacter pylori. Presse Med 1995;24(15):708–10 [in French].

13. Robbins SL, Cotran RS, Kumar V. Pathologic Basis of Disease 3rd ed. Philadelphia, PA: WB Saunders Co, 1984, 809–14.

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15. Scheiman JM. NSAIDs, gastrointestinal injury, and cytoprotection. Gastroenterology Clinics of North America 1996;25(2):279–98 [review].

16. Drake IM, Mapstone NP, Schorah CJ, et al. Reactive oxygen species activity and lipid peroxidation in Helicobacter pylori associated gastritis: relation to gastric mucosal ascorbic acid concentrations and effect of H pylori eradication. Gut 1998;42(6):768–71.

17. Waring AJ, Drake IM, Schorah CJ, et al. Ascorbic acid and total vitamin C concentrations in plasma, gastric juice, and gastrointestinal mucosa: effects of gastritis and oral supplementation. Gut 1996;38(2):171–6.

18. Jarosz M, Dzieniszewski J, Dabrowska-Ufniarz E, et al. Effects of high dose vitamin C treatment on Helicobacter pylori infection and total vitamin C concentration in gastric juice. Eur J Cancer Prev 1998;7:449–54.

19. Maruyama K, Kashiwazaki K, Toyama K, Tsuchiya M. Usefulness of Hi-Z fine granule (gamma-Oryzanol) for the treatment of autonomic instability in gastrointestinal system. Shinyaku To Rinsho 1976;25:124 [in Japanese].

20. Takemoto T, Miyoshi H, Nagashima H. Clinical trial of Hi-Z fine granules (gamma-oryzanol) on gastrointestinal symptoms at 375 hospitals (Japan). Shinyaku To Rinsho 1977;26 [in Japanese].

21. Salim AS. Sulfhydryl-containing agents in the treatment of gastric bleeding induced by non-steroidal anti-inflammatory drugs. Can J Surg 1993;36(1):53–8.

22. Farinati F, Cardin R, Della Libera G, et al. Effects of N-acetyl-L-cysteine in patients with chronic atrophic gastritis and nonulcer dyspepsia: a phase III pilot study. Curr Ther Res 1997;58:724–33.

23. Houdijk AP, Van Leeuwen PA, Boermeester MA, et al. Glutamine-enriched enteral diet increases splanchnic blood flow in the rat. Am J Physiol 1994;267(6 Pt 1):G1035–40.

24. Wilmore DW, Smith RJ, O’Dwyer ST, et al. The gut: a central organ after surgical stress. Surgery 1988;104:917–23.

25. Yan R, Sun Y, Sun R. Early enteral feeding and supplement of glutamine prevent occurrence of stress ulcer following severe thermal injury. Chung Hua Cheng Hsing Shao Shang Wai Ko Tsa Chih 1995;11(3):189–92.

26. Brzozowski T, Konturek SJ, Sliwowski Z, et al. Role of L-arginine, a substrate for nitric oxide-synthase, in gastroprotection and ulcer healing. J Gastroenterol 1997;32(4):442–52.

27. Spirichev VB, Levachev MM, Rymarenko TV, et al. The effect of administration of beta-carotene in an oil solution on its blood serum level and antioxidant status of patients with duodenal ulcer and erosive gastritis. Vopr Med Khim 1992;38(6):44–7 [in Russian].

28. Palli D, Decarli A, Cipriani F, et al. Plasma pepsinogens, nutrients, and diet in areas of Italy at varying gastric cancer risk. Cancer Epidemiol Biomarkers Prev 1991;1(1):45–50.

29. Zhang ZW, Patchett SE, Perrett D, et al. Gastric mucosal and luminal beta-carotene concentrations in patients with chronic H pylori infection. Gut 1996;38(suppl 1):A5 [abstract W11].

30. Spirichev VB, Levachev MM, Rymarenko TV, et al. The effect of administration of beta-carotene in an oil solution on its blood serum level and antioxidant status of patients with duodenal ulcer and erosive gastritis. Vopr Med Khim 1992;38:44–7 [in Russian].

31. Tsubono Y, Okubo S, Hayashi M, et al. A randomized controlled trial for chemoprevention of gastric cancer in high-risk Japanese population; study design, feasibility and protocol modification. Jpn J Cancer Res 1997;88:344–9.

32. Frommer DJ. The healing of gastric ulcers by zinc sulphate. Med J Aust 1975;22(21):793–6.

33. Mozsik G, Hunyady B, Garamszegi M, et al. Dynamism of cytoprotective and antisecretory drugs in patients with unhealed gastric and duodenal ulcers. J Gastroenterol Hepatol 1994;9 suppl 1:S88–92.

34. Kolarski V, Petrova-Shopova K, Vasileva E, et al. Erosive gastritis and gastroduodenitis—clinical, diagnostic and therapeutic studies. Vutr Boles 1987;26(3):56–9.

35. Beil W, Birkholz W, Sewing KF. Effects of flavonoids on parietal cell acid secretion, gastric mucosal prostaglandin production and Helicobacter pylori growth. Arzneimittelforschung 1995;45:697–700.

36. Bae EA, Han MJ, Kim NJ, Kim DH. Anti-Helicobacter pylori activity of herbal medicines. Biol Pharm Bull 1998;21(9):990–2.

37. Beil W, Birkholz W, Sewing KF. Effects of flavonoids on parietal cell acid secretion, gastric mucosal prostaglandin production and Helicobacter pylori growth. Arzneimittelforschung 1995;45:697–700.

38. Rekka EA, Kourounakis AP, Kourounakis PN. Investigation of the effect of chamazulene on lipid peroxidation and free radical processes. Res Commun Mol Pathol Pharmacol 1996;92(3):361–4.

39. Blumenthal M, Busse WR, Goldberg A, et al, eds. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Austin: American Botanical Council and Boston: Integrative Medicine Communications, 1998, 167.