Most people think stomach pain is just a bad meal or too much coffee. But if your discomfort lingers, comes with nausea, or shows up without any clear trigger, it could be something deeper: gastritis. It’s not just an upset stomach. It’s inflammation of the stomach lining - the same barrier that keeps your digestive acids from eating through your stomach wall. When that lining gets damaged, pain, bloating, and even bleeding can follow. And in most cases, the culprit isn’t stress or spicy food. It’s a tiny bacterium called Helicobacter pylori.

What Exactly Is Gastritis?

Gastritis means your stomach lining is inflamed. Think of it like a sunburn, but inside your gut. The stomach lining is supposed to be tough - it’s coated in mucus to protect it from strong acids and enzymes that break down food. When that protection breaks down, acid starts to irritate the tissue underneath. That’s gastritis.

There are two main types: erosive and nonerosive. Erosive gastritis means there are actual breaks or sores in the lining. These can bleed, which is why some people notice black, tarry stools or even vomit that looks like coffee grounds. Nonerosive gastritis doesn’t show visible damage, but the cells underneath are still inflamed. It’s quieter, often symptom-free, and can go on for years without anyone noticing - until it leads to something worse, like an ulcer or even stomach cancer.

About 70% to 90% of stomach ulcers are caused by H. pylori. That’s the same bacteria discovered by two Australian scientists in 1982, Barry Marshall and Robin Warren. They proved it wasn’t stress that caused ulcers - it was this little spiral-shaped germ living right in the stomach. They won the Nobel Prize for it in 2005. Today, we know H. pylori infects nearly half the world’s population. In Australia, around 20-30% of adults carry it, and it’s the number one cause of chronic gastritis.

How Do You Know If You Have It?

Symptoms vary wildly. Some people feel a burning pain right under the breastbone, especially when their stomach is empty. Others get bloated, nauseous, or feel full after eating just a bite. Vomiting and loss of appetite are common too. But here’s the catch: up to half of people with chronic gastritis have no symptoms at all. That’s why it often goes undiagnosed until something serious happens.

Red flags you shouldn’t ignore:

• Black, sticky stools (that’s digested blood)
• Vomiting blood or material that looks like coffee grounds
• Unexplained fatigue, dizziness, or shortness of breath (signs of anemia from slow bleeding)
• Weight loss without trying

If you’re having any of these, see a doctor. Don’t wait. These aren’t just "bad digestion" - they’re warning signs.

What’s Really Causing Your Gastritis?

H. pylori is the big one. It’s responsible for 70-85% of chronic cases. The bacteria cling to the stomach lining, survive the acid, and trigger a slow-burning inflammation. Over time, this can thin the lining, reduce acid production, and even change the cells - a process called atrophy. That’s a known step toward stomach cancer.

But H. pylori isn’t the only player. Regular use of NSAIDs - like ibuprofen, naproxen, or even low-dose aspirin - causes about 25-30% of gastritis cases. These drugs block protective chemicals in the stomach lining. Long-term use? That’s a recipe for damage.

Alcohol? Heavy drinking (more than 30g a day - that’s about 2 standard drinks) doubles your risk. Smoking slows healing and makes inflammation worse. Stress alone doesn’t cause gastritis, but it can make existing inflammation flare up.

Then there’s autoimmune gastritis - rare, but serious. Your immune system accidentally attacks the cells that make stomach acid and intrinsic factor (needed to absorb vitamin B12). This type mostly affects older adults and people with other autoimmune conditions like Hashimoto’s thyroiditis. Left untreated, it leads to B12 deficiency, nerve damage, and anemia.

How Is It Diagnosed?

You can’t diagnose gastritis by feeling your stomach. You need tests.

The gold standard is an endoscopy. A thin, flexible tube with a camera goes down your throat so the doctor can see your stomach lining. If they spot redness, swelling, or sores, they’ll take tiny tissue samples (biopsies) to test for H. pylori and check for cell changes.

But not everyone needs an endoscopy. For suspected H. pylori, non-invasive tests work well:

• Urea breath test: You drink a solution, then breathe into a bag. If H. pylori is present, it breaks down the solution and releases carbon dioxide you can detect. It’s 95% accurate.
• Stool antigen test: Checks for H. pylori proteins in your poop. Simple, cheap, reliable.
• Blood test: Looks for antibodies, but it can’t tell if the infection is current or past. Not ideal for confirming treatment success.

If you’re under 55, have no warning signs, and respond to acid-reducing meds, your doctor might skip the endoscopy and treat you for H. pylori first. But if you’re over 55, have weight loss, or bleeding - endoscopy is mandatory.

How Is H. pylori Treated?

Treating H. pylori isn’t just about feeling better. It’s about preventing ulcers, bleeding, and cancer. Eradication therapy is a two-pronged attack: kill the bacteria and calm the inflammation.

The standard is triple therapy: a proton pump inhibitor (PPI) like omeprazole or esomeprazole, plus two antibiotics - usually amoxicillin and clarithromycin - taken together for 10 to 14 days. Success rates? Around 80-90%… if you’re in a place where clarithromycin resistance is low.

Here’s the problem: resistance is rising. In the U.S., clarithromycin resistance jumped from 10% in 2000 to 35% in 2023. In Sydney, it’s around 25%. That means triple therapy fails more often than it works.

Newer options are changing the game:

• Bismuth quadruple therapy: PPI + bismuth + metronidazole + tetracycline. Used in high-resistance areas. Success rate: 85-92%.
• Concomitant therapy: All four drugs taken together for 10 days. Works well even with resistance.
• Vonoprazan: A new acid blocker (FDA-approved in 2022) that’s stronger and longer-lasting than PPIs. In trials, it boosted H. pylori cure rates to over 90%, even after two failed treatments.

The key? Your doctor should know local resistance patterns. If you’ve taken clarithromycin before (even for a sore throat), tell them. They might skip it entirely.

What About the Medications?

Even if you don’t have H. pylori, you still need to reduce stomach acid to let the lining heal. That’s where PPIs come in. Omeprazole, pantoprazole, lansoprazole - these are the go-to drugs. They block acid production at the source. Most people feel better within a week.

But here’s the catch: long-term PPI use can backfire. About 40% of people who stop after months or years get rebound acid hypersecretion - their stomach overproduces acid, making symptoms worse. That’s not a relapse. It’s your body overcompensating.

If you’ve been on PPIs for more than 3 months, don’t quit cold turkey. Work with your doctor to taper off slowly. Sometimes switching to H2 blockers like famotidine helps during the transition.

For NSAID-induced gastritis, the first step is stopping the drug. If you need pain relief, switch to acetaminophen. If you can’t stop NSAIDs (like for arthritis), take them with food and use a PPI long-term to protect your stomach.

What Can You Do at Home?

Medications help, but lifestyle changes are just as important:

• Avoid alcohol: Cut it out completely during treatment. Studies show symptom severity drops by 60% within two weeks.
• Quit smoking: Smoking delays healing by 35%. It’s not just about cancer - it’s about your stomach lining recovering.
• Eat smaller meals: Large meals stretch the stomach and increase acid pressure. Try five small meals instead of three big ones.
• Avoid trigger foods: Spicy, fried, or acidic foods won’t cause gastritis, but they can irritate an already inflamed lining. Pay attention to what makes you feel worse.
• Manage stress: Yoga, breathing exercises, walking - anything that lowers cortisol helps. Stress doesn’t cause gastritis, but it slows healing.

And yes, probiotics might help. Some studies show that taking Lactobacillus or Saccharomyces boulardii alongside antibiotics reduces side effects like diarrhea by up to 50%. They don’t kill H. pylori, but they make treatment easier to tolerate.

What Happens After Treatment?

You finish your antibiotics. You feel better. You think you’re done. But you’re not.

You need to confirm the bacteria is gone. That’s why a urea breath test or stool test is done 4 weeks after finishing treatment. Why wait? Because the bacteria can be temporarily suppressed by the meds, and testing too soon gives false negatives.

If the test is still positive? You’ll need a second-line therapy - usually bismuth quadruple or vonoprazan-based. About 10-15% of people need two rounds to clear it.

And if you had atrophic gastritis or intestinal metaplasia (cell changes), you’ll need ongoing monitoring. Your doctor might recommend a repeat endoscopy in 3-5 years to check for early signs of cancer.

Why This Matters More Than You Think

Gastritis isn’t just a nuisance. It’s a silent risk factor for stomach cancer. H. pylori infection increases your risk by 6 to 8 times. But here’s the good news: treating it cuts that risk in half.

In countries like Japan and South Korea, where stomach cancer is common, they screen everyone over 40 for H. pylori. If positive, they treat it - no symptoms needed. Australia doesn’t do population-wide screening yet, but if you’re over 50, have a family history of stomach cancer, or come from a high-prevalence region (Southeast Asia, Eastern Europe, parts of Africa), ask your doctor about testing.

The bottom line? Gastritis is treatable. H. pylori is curable. But you need the right test, the right treatment, and the right follow-up. Don’t let a simple stomach ache turn into something serious because you assumed it was "just indigestion."

What’s Next?

If you’ve been told you have gastritis and H. pylori, don’t panic. This isn’t a life sentence. It’s a solvable problem. The key is getting the right test, following the full treatment course, and confirming the bacteria is gone. Most people recover fully. But skipping steps - like not finishing antibiotics or not doing the follow-up test - is why so many cases come back.

If you’re not sure what’s causing your stomach pain, start with your GP. Ask: "Could this be H. pylori?" and "Do I need a breath test?" Simple questions can lead to simple solutions - and prevent a lot of pain down the road.