KATHMANDU: It’s rare to find someone who hasn’t experienced gastric problems, which is why gastritis has become a common concern among Nepalis recently.
Many people self-diagnose and purchase medication, claiming they have gastritis. Due to its widespread occurrence, gastritis is often seen as a common illness. However, doctors caution that the symptoms of gastritis should not be taken lightly or considered normal in every case.
Medical professionals explain that gastric symptoms warrant further investigation when there may be ulcers, intestinal wounds, liver issues, or even stomach cancer.
What exactly are the symptoms of gastritis? How can one determine the underlying cause? What tests are necessary? How is a proper diagnosis made? To explore these questions, we spoke with gastroenterologist Dr. Shekhar Poudel.
What is the most common disease among Nepali people in recent times?
Gastritis, commonly referred to as “gastric” in everyday language, is one of the most prevalent health issues among Nepalis today. In medical terms, adding “-itis” to any condition means inflammation. For instance, hepatitis means inflammation of the liver, appendicitis is inflammation of the appendix, and gastritis is inflammation of the stomach’s inner lining. When this lining becomes swollen due to wounds or ulcers, it is diagnosed as gastritis.
What causes gastritis?
There are three to four primary causes of gastritis. Essentially, gastritis occurs when the stomach’s inner lining becomes inflamed. The first cause is related to eating habits. Irregular meals, prolonged fasting, or consuming excessive oily and spicy foods can lead to increased gas production, which may cause ulcers and gastritis.
Secondly, the use of painkillers—especially non-steroidal anti-inflammatory drugs (NSAIDs)—can irritate the stomach lining, resulting in NSAID-induced gastritis. The third and most significant cause is infection by Helicobacter pylori (H. pylori), a bacterium that inhabits the stomach lining, weakening its defenses and gradually causing inflammation, sores, ulcers, and even cancer. This type is called H. pylori gastritis.
What is H. pylori?
H. pylori is a bacteria that was discovered in the 1990s to be the leading cause of gastritis, challenging the earlier belief that diet and lifestyle were the only culprits. This bacterium lives on the stomach lining and triggers swelling and ulcers.
Can gastritis be caused by eating or not eating?
Yes, gastritis can result from both eating and not eating. In either case, the stomach lining becomes inflamed. The stomach produces enzymes and acids to digest food. However, excessive acid production or acid working harder than necessary damages the stomach lining, leading to wounds, ulcers, and gastritis.
There are two types of acid produced: basal acid output, which is produced when the stomach is empty for a long time, and meal-induced acid, which is produced after eating. If you don’t eat for extended periods, the acid starts to erode the stomach lining. Similarly, consuming large quantities of acid-producing foods, such as oily, spicy, or flour-based items, can also trigger gastritis.
How do gastritis symptoms affect the body?
Gastritis primarily affects the upper abdominal area because the stomach is located there. Common symptoms include bloating, heartburn, nausea, acid reflux, chest pain, and sour burping. These symptoms strongly indicate gastritis.
Sometimes, people report unrelated symptoms like headaches or leg pain. However, these are usually linked to stress or panic, not directly caused by gastritis without accompanying stomach discomfort. Diarrhea alone does not indicate gastritis and requires proper medical evaluation.
What tests help diagnose gastritis?
Diagnosis typically begins with assessing symptoms such as upper abdominal burning and pain, especially if symptoms improve with medication. Endoscopy is a key diagnostic tool, allowing doctors to view the stomach lining directly.
Video X-rays are also used, not to detect gastritis directly but to rule out other issues such as gallstones or liver problems. If these tests show no abnormalities but pain persists, gastritis is often the diagnosis.
Testing for H. pylori infection can be done through three main methods: endoscopy with biopsy (removal of a small tissue sample), stool tests to detect bacterial presence, and the urea breath test, where the patient ingests urea, and the carbon dioxide exhaled is measured to detect H. pylori.
When should further testing be done?
For young patients with mild symptoms like stomach pain and heartburn, doctors may prescribe medication initially. However, if symptoms are severe or accompanied by weight loss, vomiting, loss of appetite, or anemia, comprehensive tests are necessary to rule out other serious conditions.
Does H. pylori only cause gastric problems, or does it contribute to other diseases?
- pylori is a bacterium (not a virus) that has been living in humans for centuries. It is believed that as humans migrated from Africa to other parts of the world, they already carried H. pylori in their stomachs. In Nepal, around 70 to 80 percent of people are infected with H. pylori, but only some develop health problems from it.
About 10 to 15 percent of those infected experience gastritis or stomach ulcers, and roughly 1 percent may develop stomach cancer. While some sources suggest H. pylori might be linked to other conditions like low blood pressure, low platelet counts, or gallbladder cancer, there is no strong scientific evidence supporting these claims. Most infected people do not experience any symptoms or health issues.
Is gastritis a disease itself or a symptom of other diseases?
Gastritis is a disease characterized by inflammation of the stomach’s inner lining. It produces digestive symptoms like loss of appetite, heartburn, bloating, and nausea. However, these symptoms can also be caused by other conditions, such as gallbladder stones, pancreatic problems, or even stomach and liver cancer, especially in older individuals who smoke or drink alcohol.
Because these symptoms overlap with other diseases, it is important to diagnose gastritis carefully, considering the patient’s age, habits, and overall health before starting treatment.
What about alternative treatments like Ayurveda or homeopathy for gastritis?
Many people try remedies ranging from traditional healers (Dhamijhakri) to Ayurveda, homeopathy, or allopathy. While mild gastritis symptoms might improve with some treatments, incorrect or delayed diagnosis—especially in serious cases like stomach cancer—can worsen the outcome.
If symptoms persist, or if there are warning signs like weight loss or low blood pressure, proper medical testing is essential to confirm whether it’s gastritis or something more serious. Only after diagnosis should medicine, dietary changes, and lifestyle adjustments be made.
It’s also important to realize that gastritis is often related to diet and lifestyle, so even if treated successfully, poor habits like smoking, drinking, or eating fatty foods can cause it to flare up again.
Can gastric ulcers develop into cancer?
The idea that gastric ulcers directly develop into cancer is a misconception. Some people may have ulcers without symptoms, while others have symptoms without ulcers. Untreated, persistent symptoms can lead to ulcers, but ulcers themselves do not directly cause cancer.
Most stomach cancers are linked to chronic H. pylori infection combined with risk factors like alcohol use and smoking. This leads to changes in the stomach lining called intestinal metaplasia, where normal cells start transforming abnormally (dysplasia), which can eventually progress into cancer.
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