Gastritis: Symptoms, Helicobacter pylori & Treatment

At a glance

Frequency One of the most common stomach diseases; H. pylori prevalence in Germany around 30%
Most common cause Helicobacter pylori — responsible for a large share of the chronic cases
Forms Acute (mostly temporary) vs. chronic — type A (autoimmune), type B (H. pylori), type C (chemical)
Curable Acute: mostly yes. Type B: generally curable through eradication. Types A and C: controllable
Medications (selection) PPIs (omeprazole, pantoprazole), bismuth quadruple therapy for H. pylori, antacids
ICD-10 K29

Table of contents

  1. What is gastritis?
  2. Acute vs. chronic — the three types
  3. Symptoms and warning signs
  4. Causes and risk factors
  5. Diagnosis: gastroscopy & H. pylori test
  6. Medication and treatment
  7. Diet with gastritis
  8. Complications
  9. Living with gastritis
  10. How brite helps you
  11. FAQ
  12. Related topics

1. What is gastritis?

Gastritis refers to an inflammation of the gastric mucosa — the protective layer that lines the inner wall of the stomach. Normally this mucosa produces stomach acid for digestion and at the same time mucus and bicarbonate to protect the stomach wall. With gastritis, this delicate balance is usually disturbed.

Gastritis ≠ heartburn ≠ stomach ulcer With heartburn/reflux, stomach acid rises into the esophagus. With gastritis, the gastric mucosa itself is inflamed. A stomach ulcer is usually a deeper defect — a gastritis left untreated for a longer time can, however, lead to an ulcer.¹

Interesting: a large proportion of people with a Helicobacter pylori infection have no or hardly any symptoms. In these cases the gastritis often remains unnoticed — but can nevertheless have long-term consequences.¹

2. Acute vs. chronic — the three types

Acute gastritis

Acute gastritis usually occurs suddenly — often within a few hours. Common triggers are excessive alcohol consumption, certain painkillers (NSAIDs: ibuprofen, diclofenac, ASA), severe stress (e.g. in the intensive care unit) as well as acute infections (e.g. noroviruses or food poisoning).

The symptoms can be severe at first, but mostly subside completely after the cause is removed. The duration is usually in the range of a few days to a few weeks.

Chronic gastritis — the three ABC types

Type A Autoimmune gastritis

A rarer form: the immune system attacks the acid-producing parietal cells of the stomach. Possible consequences: reduced stomach acid production and disturbed absorption of vitamin B12 (up to pernicious anemia). Usually the body of the stomach is affected. Not rarely occurs together with other autoimmune diseases — e.g. Hashimoto's thyroiditis, type 1 diabetes. Not curable, but generally well controllable — especially through medically supervised vitamin B12 supplementation. Regular endoscopic checks are often recommended.

Type B Bacterial (Helicobacter pylori) — most common form

By far the most common form of chronic gastritis. Caused by the bacterium Helicobacter pylori, which can survive in the acidic stomach environment. In Germany, the H. pylori prevalence is around 30%. Typically the stomach outlet (antrum) is affected. An untreated infection can lead to stomach and duodenal ulcers, a MALT lymphoma and an increased risk of gastric carcinoma. Type B gastritis is generally considered curable — through a combined antibiotic therapy (eradication, section 6). According to the current S2k guideline, a detected H. pylori should generally be eradicated.¹

Type C Chemical (NSAIDs, bile acid reflux, alcohol)

Caused by a chemical irritation of the mucosa — most often by NSAID painkillers (ibuprofen, diclofenac, ASA) or bile acid reflux (e.g. after stomach surgery). Therapeutically important: avoid the triggering substance as far as possible; in addition, a PPI is often used as stomach protection. When NSAIDs are medically necessary (e.g. with rheumatoid arthritis), a PPI is usually prescribed alongside on a permanent basis.¹

3. Symptoms and warning signs

Typical symptoms

  • Burning or dull pain in the upper abdomen — often after eating, sometimes also on an empty stomach
  • A feeling of pressure, fullness and bloating — especially after meals
  • Nausea and occasional vomiting
  • Loss of appetite
  • Heartburn and acid regurgitation
  • Upper abdominal pain that can partly radiate into the back
  • An unpleasant taste in the mouth
Warning signs — have them evaluated by a doctor immediately Blood in the vomit (fresh red or coffee-ground-like) · Black, tarry stool (melena) · Very severe, sudden, persistent abdominal pain · Dizziness, weakness or circulatory problems in combination with stomach complaints · Unintentional weight loss over several weeks. With signs of bleeding or very severe upper abdominal pain, call 112 immediately (in the US: 911).

4. Causes and risk factors

The three main causes

Helicobacter pylori
Responsible for the majority of chronic gastritis. Prevalence in Germany around 30% (tending to decline). Transmission probably oral-oral or fecal-oral, mostly in childhood. Without therapy, the infection can lead to a lifelong chronically active inflammation. Relevant risk factors: lower socioeconomic status, infected family members, origin from regions with high prevalence.¹
NSAID painkillers (ibuprofen, diclofenac, ASA)
Inhibit, among others, the enzyme COX-1, which is important for the protection of the gastric mucosa. The risk rises with dose and duration. The combination of NSAIDs with cortisone or blood thinners is considered particularly risky. A more stomach-friendly alternative in many situations: paracetamol (acetaminophen). When NSAIDs are medically necessary, a PPI is often used as stomach protection.¹
Autoimmune
The immune system attacks the parietal cells of the stomach. Rarer than H. pylori gastritis — often occurs in combination with other autoimmune diseases.

Further risk factors

  • Alcohol — can directly irritate the gastric mucosa, especially high-proof on an empty stomach
  • Smoking — can impair the regeneration of the mucosa
  • Chronic stress — can reduce the blood supply to the mucosa
  • Long-term cortisone therapy — especially in combination with NSAIDs
  • Bile acid reflux — e.g. after stomach surgery or with motility disorders
  • Older age — the risk of atrophic gastritis and gastric carcinoma increases

5. Diagnosis: gastroscopy and H. pylori test

Not every person with stomach complaints needs a gastroscopy right away. In younger patients without warning signs, a non-invasive test for H. pylori can first be considered (so-called "test-and-treat"). The decision is always made by the treating doctor.¹

Gastroscopy — when recommended?

  • Warning signs (signs of bleeding, unintentional weight loss, difficulty swallowing)
  • First manifestation at an older age
  • A lack of treatment success
  • Suspicion of a stomach ulcer or a malignant change
  • Follow-up check after eradication therapy with a pre-existing ulcer
Gastroscopy (gold standard)
Via a flexible endoscope, the gastric mucosa is assessed directly. Tissue samples (biopsies) for histology and a rapid test for H. pylori (urease test) can be taken. Sedation is possible on request. Important: PPIs should generally be paused a few weeks before an H. pylori detection — they can falsify the test result.¹
¹³C urea breath test
Considered the most accurate non-invasive test. The patient drinks a labeled urea solution — if H. pylori is present, the urea is split and becomes measurable in the breath. Also used to check success after eradication.¹
Stool antigen test
Detection of H. pylori antigens in the stool. Simple to carry out, also well suited for children. Informative value comparable to the breath test.
Blood test (antibodies)
Generally only shows whether an infection ever existed — not whether one is currently still present. For a follow-up check it is mostly not suitable.
H. pylori test only after a PPI pause! An H. pylori test should generally be done only a few weeks after stopping PPIs and a few weeks after antibiotic therapy — otherwise false-negative results are possible. The exact time intervals are determined by the treating doctor.

More: Preparing for a doctor's appointment.

6. Medication and treatment

Which medications make sense in an individual case is always decided by the treating doctor — usually on the basis of the current S2k guideline on Helicobacter pylori and gastroduodenal ulcer disease.¹˒²

Proton pump inhibitors (PPIs) — the most important group of medications

PPIs: omeprazole, pantoprazole, esomeprazole
Markedly reduce acid production in the stomach and thus take the pressure off the inflamed mucosa.
Intake: Usually in the morning on an empty stomach, some time before breakfast
Duration: Determined individually — from a few weeks with acute gastritis to a permanent therapy as stomach protection with necessary NSAID treatment
Long-term side effects: Among others, vitamin B12 or magnesium deficiency, an increased risk of certain intestinal infections; in older people possibly an increase in the risk of bone fractures³
No abrupt stopping: When stopping, an increased acid production can temporarily occur (rebound effect). A slow tapering off according to medical recommendation. More: Stopping medications

H. pylori eradication — current first line according to the S2k guideline 2023

Important change: clarithromycin triple therapy no longer first line The updated S2k guideline has changed the recommendation: the formerly often used standard therapy (PPI + clarithromycin + amoxicillin) is today generally no longer recommended in Germany as an empirical first line — the background is increasing clarithromycin resistance.¹˒²
Empirical first line: bismuth quadruple therapy (new)
Scheme: PPI + bismuth + tetracycline + metronidazole over at least 10 days
Available in Germany: A fixed combination pack (3-in-1 capsule) in combination with omeprazole
Advantage: Generally usable largely independently of clarithromycin resistance
Common side effects: Nausea, a metallic taste in the mouth, dark-colored stool (from bismuth — mostly harmless)
Avoid alcohol during the therapy!¹˒²
Alternative first line: concomitant quadruple therapy
PPI + amoxicillin + clarithromycin + metronidazole over usually 14 days. Considered in individual cases.
After treatment failure
According to the S2k guideline, resistance testing is recommended. The second-line therapy is then guided by the resistance profile — possible options include, among others, fluoroquinolone-based regimens. A few weeks after the end of therapy: a success check by breath test or stool antigen test (after a PPI pause).
Carry out the eradication therapy completely! All medications should be taken to the end — even if the symptoms already ease earlier. Stopping early can promote resistance and render the therapy ineffective. More: Taking antibiotics correctly.

Further medications

H2 receptor blockers (e.g. famotidine)
Acid suppression is generally weaker than with PPIs, but the onset of action is often somewhat faster. A possible option with PPI intolerance or for short-term use — after medical advice.
Antacids (e.g. Maaloxan, Rennie, Talcid)
Neutralize the stomach acid directly. Quick, but mostly only short-term relief. Generally do not heal the inflammation — they serve for symptom treatment.
Sucralfate
Forms a protective film over the inflamed mucosa or an ulcer. Taken usually on an empty stomach before meals — according to medical instruction. More: Taking medications before or after meals.

7. Diet with gastritis — what helps, what harms

Diet alone generally does not heal gastritis — but it can support healing and considerably relieve symptoms. What is decisive above all is individual tolerance.

Rather avoid in the acute phase
  • Alcohol — can directly irritate the mucosa
  • Coffee on an empty stomach
  • Very hot spices with a known sensitivity
  • Very fatty food (fried, breaded dishes)
  • Very acidic foods (citrus fruits)
  • Strongly carbonated drinks
Usually well tolerated
  • Porridge — classically gentle on the stomach
  • Potatoes, rice, pasta
  • Steamed vegetables (carrots, zucchini, fennel)
  • Bananas — considered stomach-friendly
  • Chamomile tea — traditionally soothing to the stomach
  • Lean meat or fish, steamed
  • Yogurt if well tolerated
General dietary tips Several smaller meals instead of a few large ones · Eat slowly and chew well · Do not eat directly before going to bed · Foods neither very hot nor ice cold · A food diary can help identify individual triggers

8. Complications: stomach ulcer and gastric cancer risk

  • Stomach ulcer (ulcus ventriculi/duodeni): A deeper defect in the mucosa — often in connection with H. pylori or NSAIDs. Possible complications: bleeding or perforation (a breakthrough of the stomach wall) — the latter is a medical emergency.
  • Stomach bleeding: Warning signs: tarry stool, coffee-ground-like vomit, circulatory weakness — call 112 immediately (in the US: 911).
  • Atrophic gastritis and gastric cancer risk: A long-term H. pylori infection can lead to mucosal atrophy and intestinal metaplasia — and increase the risk of a gastric carcinoma. An eradication can generally lower this risk, especially when it is done early. With advanced atrophy or metaplasia, regular endoscopic checks are often recommended.¹
  • Vitamin B12 deficiency: Can occur with type A gastritis and — in some cases — with very long-term PPI intake. Possible signs: pronounced fatigue, paleness, tingling in the hands or feet, concentration problems.

9. Living with gastritis

  • Stress: Considered one of the most important aggravating factors. Relaxation techniques (e.g. progressive muscle relaxation, breathing exercises, yoga), sufficient sleep and regular exercise can generally help.
  • Painkillers: Ibuprofen, diclofenac and ASA should be avoided as far as possible with an active gastritis. A more stomach-friendly alternative: paracetamol (acetaminophen). When NSAIDs are medically necessary, a PPI is often prescribed alongside.
  • Smoking: Can mostly worsen a gastritis and delay healing. Stopping smoking can generally support recovery considerably.
  • Alcohol: In the acute phase, complete abstinence is often sensible. More: Medications and alcohol.
  • PPI intake: Usually in the morning on an empty stomach, some time before breakfast. Do not stop abruptly. Have the need checked by a doctor regularly. More: Taking medications before or after meals.

How brite helps you with gastritis

From the PPI reminder in the morning on an empty stomach to the bismuth quadruple therapy several times a day — brite keeps the overview.

  • Intake reminder — PPI in the morning on an empty stomach, bismuth quadruple therapy several times a day, antibiotics on time: brite reminds you reliably of every dose. Set up a reminder
  • Interaction check — PPIs and antibiotics can interact with other medications. Check for free. Check now
  • Health history — document symptoms and possible triggers day by day and recognize patterns. Track your history
  • Digital medication plan — all medications clearly organized for gastroenterology, GP and pharmacy. Go to medication plan
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FAQ: Common questions about gastritis

An acute gastritis generally heals completely again after the cause is removed. A chronic type B gastritis (Helicobacter pylori) is considered well treatable through an eradication therapy. Type A gastritis (autoimmune) is not curable, but generally well controllable — among other things through medically supervised vitamin B12 supplementation. Type C gastritis (chemical) is mostly controllable by avoiding the triggering substance and using stomach protection.¹
An acute gastritis generally lasts a few days to a few weeks. A chronic gastritis can persist for months or years without treatment. With a suitable therapy, the symptoms often improve within a few weeks. An H. pylori eradication generally extends over around 10 to 14 days; the success check is usually done a few weeks later.
In the acute phase, coffee is often not well tolerated — especially on an empty stomach, because it can stimulate acid production. After an improvement, coffee in moderation and not on an empty stomach can be possible again in many cases. Sometimes coffee with milk is better tolerated than black coffee.
Transmission probably occurs oral-oral or fecal-oral and mostly happens already in childhood — often within the family. A new infection in adulthood is generally considered rare in industrialized countries. After a successful eradication, a renewed infection is rather unlikely.¹
The updated S2k guideline has changed the first-line therapy: the formerly usual triple therapy with clarithromycin is today generally no longer recommended in Germany as an empirical first line — the background is increasing clarithromycin resistance. The new empirical first line is generally the bismuth quadruple therapy over at least 10 days (PPI + bismuth + tetracycline + metronidazole).¹˒²
That depends on the situation. With an acute gastritis, a few weeks are generally sufficient; afterwards a slow tapering off can be sensible. With a necessary long-term NSAID therapy, the PPI is mostly taken in parallel as stomach protection. Important: the need should be checked by a doctor regularly — PPIs should not simply be continued permanently without a reason.³
A long-term H. pylori infection can increase the risk of a gastric carcinoma. An eradication can generally lower this risk — especially when it is done early. With advanced mucosal atrophy or metaplasia, regular endoscopic checks are often recommended. A slightly increased risk is also described with type A gastritis.¹
As a more stomach-friendly alternative, paracetamol (acetaminophen) is used in many situations. Ibuprofen, diclofenac and ASA should be avoided as far as possible with an active gastritis. When NSAIDs are medically necessary, a PPI is usually prescribed as stomach protection alongside. The decision is always made by the treating doctor.
After an abrupt PPI stop, stomach acid production can be temporarily increased (the so-called rebound effect) — this can worsen the symptoms in the short term. A slow tapering off according to medical recommendation is therefore mostly sensible. More: Stopping medications.

12. Related topics

Heartburn and reflux Irritable bowel syndrome Stomach problems from medications Taking antibiotics correctly Taking medications before or after meals Stopping medications Medications and alcohol Drug interactions Side effects of medications

Sources

  1. S2k-Leitlinie „Helicobacter pylori und gastroduodenale Ulkuskrankheit" (DGVS, AWMF Reg-Nr. 021-001), Aktualisierung 2023. awmf.org
  2. Fischbach W. et al.: Aktualisierte S2k-Leitlinie Helicobacter pylori und gastroduodenale Ulkuskrankheit (Z Gastroenterol 2023; 61: 544–606). pmc.ncbi.nlm.nih.gov
  3. gesundheitsinformation.de (IQWiG): Magenschleimhautentzündung (Gastritis). gesundheitsinformation.de
  4. Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS). dgvs.de
  5. Apotheken Umschau: Gastritis — Patienteninformation. apotheken-umschau.de
Medical disclaimer: This article is for general information and does not replace medical advice, diagnosis or treatment. The choice of medication and dosages are always determined individually by the treating doctor. With blood in the vomit, black stool or severe, sudden upper abdominal pain, seek medical help immediately — in acute emergencies via the emergency number 112 (in the US: 911). Before an H. pylori test, the necessary PPI pause should be coordinated with the treating practice. Last updated: April 2026.