Is it gastritis or something else?
- thegutremedy
- Jul 17
- 10 min read
Updated: Aug 16
What is gastritis?
Gastritis means inflammation of the stomach lining. It can be acute (sudden onset from things like NSAIDs, alcohol, or food poisoning) or chronic (gradual and often linked to infections like H. pylori, autoimmune issues, or long-term irritation from stress, diet, or smoking) [1].
A lot of people assume that stomach inflammation means you have too much acid, but chronic gastritis can actually lower acid production by damaging the parietal cells that make it [2]. This can lead to hypochlorhydria (low stomach acid), making it harder to digest protein and absorb nutrients like B12, iron, and magnesium. The Heidelberg test can help check your acid levels if you’re unsure.
Low stomach acid doesn’t just affect digestion - it also weakens your defences against bacteria and infections, which is why SIBO and other gut infections often follow gastritis (or treatment for it, which usually involves stomach acid suppressants) [3].
There’s also atrophic gastritis, a longer-term thinning of the stomach lining, usually autoimmune. It raises the risk of nutrient deficiencies and, in rare cases, cancer if left untreated - but it’s absolutely manageable with support [4].
As well as making acid, your stomach lining also produces mucus (to protect itself) and intrinsic factor (to absorb B12). When it’s inflamed, none of these systems work properly, and that’s when symptoms creep in.
My experience with gastritis
My own experience with gastritis started after being prescribed naproxen (an NSAID). I wasn’t given a PPI to protect my stomach and, to be honest, I didn’t always take it with food (big mistake). Within a few days, I was hit with intense stomach pain I’d never felt before. It felt like a burning, gnawing ache that flared after eating and when lying down.
An endoscopy confirmed mild reactive gastropathy (inflammation of the stomach lining due to prolonged exposure to irritants like NSAIDs). I was relieved to have an answer, and like most people, I was prescribed PPIs to help my stomach heal. And they did help, at least initially.
But what started as stomach pain soon turned into bloating, post-meal discomfort, and a growing list of food intolerances. My gut was clearly struggling, but it wasn’t just my stomach anymore. While the PPIs helped calm the gastritis, they also lowered my stomach acid, disrupting the microbiome. I later learned that NSAIDs can directly damage the small intestine [5], and that damage is often worsened when the gut flora is thrown off by acid suppression [6].
So while I thought I was treating the problem, I hadn’t realised my small intestine needed just as much support. Until I addressed both, the symptoms just kept cycling back.
What are the symptoms of gastritis?
Gastritis isn't always easy to spot as some people are basically asymptomatic and others are completely flattened by pain.
Common symptoms include:
Burning or gnawing pain in the upper abdomen (often worse on an empty stomach)
Nausea or queasiness, especially after eating
Bloating or belching
Indigestion or a general sense of food just sitting there
Loss of appetite or feeling full very quickly
Acid reflux or a sour taste in the mouth
Burping up food or acid hours after eating
Hiccups, especially if persistent
Vomiting (occasionally with blood if the lining is badly inflamed)
Black or tarry stools - a sign of bleeding higher up in the digestive tract
Fatigue or lightheadedness, often linked to low iron or B12
Food intolerances, especially to spicy, acidic, or fatty foods
Something that often gets overlooked is delayed gastric emptying. When the stomach lining is inflamed, it doesn’t just cause pain, it can also slow down how quickly your stomach empties food into the small intestine [7]. That delay leads to reflux, bloating, nausea, burping, and that heavy, stuck feeling after meals. It can even make you feel full after just a few bites, which over time can really affect your appetite and nutrition. Personally, this was probably my worst symptom of gastritis.
Some people only know they have gastritis when it is detected on an endoscopy. Some people feel a vague discomfort. Others notice they can’t tolerate foods they used to love. And some get hit hard and struggle to eat anything other than the blandest foods. The symptoms can come and go, change, or in the case of chronic gastritis, sit quietly in the background for months before anything feels clearly wrong.
What causes gastritis?
The root causes of gastritis are diverse. Often, it’s not just one thing, but a perfect storm of triggers that ends up inflaming the stomach lining. Some of the most common culprits include [8]:
NSAIDs (like ibuprofen, naproxen): Among the biggest offenders. They reduce inflammation in the body, but also reduce the protective mucus in your stomach lining, leaving it vulnerable to acid damage, especially when taken without food or without a protective PPI.
Alcohol: Especially on an empty stomach, alcohol can irritate and inflame the stomach lining.
Stress: Chronic emotional stress can alter gut motility and reduce blood flow to the digestive tract. It can increase stomach acid in the short term, and may impair healing in the long term.
Helicobacter pylori (H. pylori): This corkscrew-shaped bacteria burrows into the stomach lining and weakens its protective barrier. It’s strongly linked to ulcers and chronic gastritis.
Autoimmunity: In autoimmune gastritis, the body mistakenly attacks its own parietal cells (the ones that make stomach acid), leading to inflammation, acid loss, and eventually nutrient deficiencies (particularly vitamin B12).
Smoking: Reduces blood flow to the stomach, slows healing, and increases acid production. It also makes H. pylori more aggressive and harder to eradicate.
Spicy or acidic foods: Rarely a sole cause but can seriously aggravate symptoms if your lining is already inflamed.
Skipping meals: Also rarely the only cause but when the stomach is empty for long periods, acid can irritate the lining directly, especially if protective mucus is low.
Bile reflux: In some cases, bile (from the small intestine) flows backward into the stomach, irritating the lining.
Overtraining or intense exercise: On an empty stomach, this can reduce blood flow to the gut and trigger inflammation.
Nutrient deficiencies: Low levels of zinc, vitamin A, or B vitamins can reduce the body’s ability to maintain and repair the stomach lining.
Chronic infections or parasites: Can lead to low-grade, ongoing inflammation in the gut, including the stomach.
Poor oral health: Really! Poor dental hygiene can increase the bacterial load you’re swallowing daily, potentially contributing to gut and stomach dysbiosis.
Radiotherapy or chemotherapy
There’s not always one clear cause. Maybe you’re under a lot of stress, drink a bit too much on an empty stomach, have a few nutrient gaps, and suddenly your gut just says ‘enough’. But really, it’s the build-up of all those factors that sets the inflammation in motion.
What else could it be?
Not all upper abdominal pain is gastritis. In fact, lots of gut conditions can mimic or have symptom overlap with it. I spent years thinking my gastritis hadn’t healed when actually, the pain was coming from my small intestine. So if your endoscopy looks clear, or your gastritis isn’t responding to the usual treatments, it’s worth exploring what else might be going on [8][9]:
Functional dyspepsia: Chronic indigestion without an obvious cause. You might feel bloated, full after small meals, or just uncomfortable after eating despite a normal endoscopy.
SIBO (Small Intestinal Bacterial Overgrowth): Often shows up with bloating, pain, belching, and food sensitivities, especially when digestive juices are low or motility is off.
Small intestinal inflammation: Often missed on testing (endoscopies can’t get down that far and colonoscopies can’t get up that far!) but inflammation lower down in the gut can feel very similar to gastritis. It’s something I personally dealt with, caused by NSAIDs and worsened by PPIs, and it can lead to post-meal pain, bloating, and nutrient malabsorption.
GERD (acid reflux): Can mimic gastritis, but the pain is usually higher up and affects the oesophagus, not the stomach lining.
Peptic ulcers: Deeper erosions in the stomach or duodenum, shown on endoscopy. Similar pain, but potentially more serious as they can bleed or perforate.
Gallbladder or Pancreatic issues: Can cause upper abdominal pain, especially after eating fatty foods. Often confused with stomach pain.
Gastroparesis: Delayed stomach emptying, which can result from chronic inflammation, some medications, nerve dysfunction and as a result of other conditions such as diabetes, hypothyroidism and viral infections. Symptoms include nausea, reflux, and fullness after small meals.
Bile reflux: A backflow of bile from the small intestine into the stomach. Feels like acid reflux but isn’t helped by acid blockers. Can also be a cause of gastritis (as above).
Food intolerances (like gluten, FODMAPs, or histamine intolerance): Can mimic gastritis symptoms without any visible inflammation.
Celiac disease: Can show up with vague upper GI symptoms, nutrient deficiencies, and inflammation in the small intestine.
Nervous system dysregulation: Chronic stress can affect gut motility and perception of pain. Sometimes, it’s not what’s happening physically, but how your nervous system is interpreting it.
If your symptoms don’t improve, or you feel worse despite the classic gastritis treatment plan, try zooming out. You might be treating the wrong part of your gut or missing a piece of the puzzle entirely.
How is gastritis diagnosed?
For something that can cause so much discomfort, gastritis isn’t always easily diagnosed. Diagnosis normally involves [10]:
Endoscopy: The gold standard for diagnosing gastritis. A small camera is passed through your mouth into the stomach to visually assess the lining. It can confirm inflammation, ulcers, or more serious conditions, and biopsies can check for H. pylori and atrophic changes. That said, mild inflammation can be missed, especially if it’s patchy or further down in the digestive tract.
Biopsy for H. pylori: If you're having an endoscopy, a small tissue sample is often taken to test for H. pylori, a common bacterial trigger. If an endoscopy isn't possible, stool antigen tests or breath tests can also be used.
Stool tests: These can detect H. pylori, signs of bleeding, or inflammatory markers like calprotectin.
Blood tests: Used to diagnose autoimmune gastritis with an anti-parietal cell antibody test.
Heidelberg test: A test which measures stomach acid levels in real time using a swallowed capsule. It can help confirm hypochlorhydria, especially in cases where gastritis has damaged the acid-producing cells.
While testing can be helpful, it’s not always definitive. If you’ve had a clear endoscopy but still feel awful, you’re not imagining things! It just means the next step might be digging a little deeper for answers.
How do you treat gastritis?
Treating gastritis isn’t always straightforward. For some people, it clears up quickly with a course of PPIs and a few dietary tweaks. For others, it can involve a bit more trial and error.
Here are the common treatment options:
1. PPIs and Acid Blockers:
Most people are prescribed a proton pump inhibitor (PPI) like omeprazole or lansoprazole to reduce stomach acid and give the lining time to heal. They can be really helpful short term, but they don’t tackle the why behind the inflammation, and long-term use can come with knock-on effects (more on that next).
2. Treating H. pylori:
If H. pylori is detected, your doctor may suggest triple therapy (a PPI and two antibiotics). There are also natural options like mastic gum, L. Reuteri probiotic, DGL, and berberine which can be trialled with practitioner support.
3. Removing Triggers:
If NSAIDs, alcohol, or chronic stress played a role in your gastritis, you should remove those to stop continually irritating your stomach lining.
Supporting your vagus nerve and nervous system regulation (through breathwork, meditation, or simply slowing down meals) can reduce symptoms and improve digestion, especially if stress is a major trigger.
5. Natural Supports:
These are often used alongside or after conventional treatment:
Zinc carnosine: promotes stomach lining repair
DGL: protects and soothes
Slippery elm and marshmallow root: help with mucosal healing
Mastic gum: useful for H. pylori or general inflammation
L-glutamine: particularly helpful if the small intestine is also affected
6. Rebuilding the Gut:
If you’ve been on PPIs or antibiotics, there’s a good chance your small intestine and microbiome may need some support too. This might mean rebalancing gut bacteria with probiotics, addressing SIBO gently if needed, or improving motility.
What should I eat with gastritis?
What you eat can make a huge difference to gastritis, but there's no single ‘gastritis diet’ that works for everyone. It's about working out what affects your body, reducing irritation, and supporting healing. Here are some guidelines that may help:
Soothing foods:
Soups and broths
Stewed or cooked fruits (like apples or pears)
Porridge or oats
Root vegetables
Cooked greens
Bone broth, rice, and simple proteins
Irritating Foods:
Alcohol, coffee, and carbonated drinks
Citrus fruits, tomatoes, and vinegar
Raw salad or fibrous veg (like kale, cabbage, or broccoli)
Spicy foods, fried foods, and anything overly processed
Large meals or heavy dinners late at night
Helpful eating habits:
Eat smaller, more frequent meals
Chew slowly and eat mindfully
Don’t eat on the go or when you’re stressed - your nervous system matters
Avoid lying down straight after eating
Think about texture and temperature - many people do better with warm, soft foods
Everyone is different. One person might tolerate a little lemon in warm water while someone else might flare with even a few raw greens. You will find endless ‘gastritis diet’ resources online, but try to focus on what feels good, not just what’s on a list. If you tolerate a (healthy) food, there is no need to avoid it, whatever the lists may say!
When PPIs help – and when they might hurt
PPIs can be incredibly helpful for calming an inflamed stomach, especially in the short term. They reduce acid, which gives the lining a chance to heal and can bring relief from burning, nausea, or pain.
But they’re not a long-term fix. If you stay on them too long, they can cause low stomach acid, disrupt your microbiome, and worsen symptoms like bloating, food intolerances, and nutrient deficiencies, especially if your small intestine is already struggling [11].
In my case, they helped at first, but over time they made my small intestinal symptoms worse. I didn’t realise how much they were affecting my digestion until I started focusing on what was happening beyond just the stomach.
If you're using PPIs, just make sure you have a plan. And if you're thinking about coming off them, taper slowly with support as suddenly stopping can make things worse before they get better [12].
To sum up:
Gastritis isn’t always easy to diagnose or treat. Sometimes it comes on suddenly and knocks you flat. Other times, it shows up as vague discomfort, food sensitivities, or a general feeling that something’s just not right. And while standard treatments like PPIs can be very helpful, they don’t always get to the root.
If your symptoms linger, change, or come back even after treatment, it’s worth looking beyond just the stomach at your small intestine, microbiome, nervous system, diet, and stress levels. True healing often means supporting the whole gut.
You will heal. Maybe not overnight, and maybe not in a straight line, but healing is absolutely possible with the right support, the right tools, and a little patience.
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