Gastritis:
Symptoms, Helicobacter pylori & Treatment

At a glance

Frequency One of the most common stomach conditions; H. pylori prevalence in Germany around 30%
Most common cause Helicobacter pylori — responsible for the majority of chronic cases
Types Acute (mostly transient) vs. chronic — Type A (autoimmune), Type B (H. pylori), Type C (chemical)
Curable Acute: usually yes. Type B: generally curable via 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 testing
  6. Medications and treatment
  7. Diet for gastritis
  8. Complications
  9. Living with gastritis
  10. How brite helps you
  11. FAQ
  12. Related topics

1. What is gastritis?

Gastritis means an inflammation of the gastric mucosa — the protective lining of the inside of the stomach. Normally, this mucosa produces stomach acid for digestion and at the same time mucus and bicarbonate to protect the stomach wall. In gastritis, this delicate balance is usually disturbed.

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

Notably, the majority of people with a Helicobacter pylori infection have few or no symptoms. The gastritis often goes unnoticed in these cases — but can still have long-term consequences.¹

2. Acute vs. chronic — the three types

Acute gastritis

Acute gastritis generally comes on suddenly — often within a few hours. Common triggers are excessive alcohol consumption, certain painkillers (NSAIDs: ibuprofen, diclofenac, aspirin/ASA), severe stress (e.g. in intensive care) and acute infections (e.g. norovirus or food poisoning).

Symptoms can be intense at first but usually resolve completely once the cause is removed. The duration is generally 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 impaired absorption of vitamin B12 (up to pernicious anemia). The gastric body is usually affected. Not uncommonly occurs together with other autoimmune conditions — e.g. Hashimoto's thyroiditis, type 1 diabetes. Not curable, but generally well manageable — particularly with medically supervised vitamin B12 supplementation. Regular endoscopic follow-up is 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, H. pylori prevalence is around 30%. The gastric outlet (antrum) is typically affected. An untreated infection can lead to gastric and duodenal ulcers, MALT lymphoma and an increased risk of gastric cancer. Type B gastritis is generally considered curable — through combination antibiotic therapy (eradication, see section 6). According to the current S2k guideline, a confirmed H. pylori infection should generally be eradicated.¹

Type C Chemical (NSAIDs, bile reflux, alcohol)

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

3. Symptoms and warning signs

Typical complaints

  • Burning or dull pain in the upper abdomen — often after eating, sometimes also on an empty stomach
  • Feeling of pressure, fullness and bloating — especially after meals
  • Nausea and occasional vomiting
  • Loss of appetite
  • Heartburn and acidic belching
  • Upper abdominal pain that can in some cases radiate to the back
  • An unpleasant taste in the mouth
Warning signs — see a doctor immediately Blood in vomit (fresh red or coffee-ground-like) · Black, tarry stool (melena) · Very severe, sudden, persistent abdominal pain · Dizziness, weakness or circulatory problems combined with stomach symptoms · Unintended weight loss over several weeks. With signs of bleeding or very severe upper abdominal pain, call 112 immediately.

4. Causes and risk factors

The three main causes

Helicobacter pylori
Responsible for the majority of chronic gastritis. Prevalence in Germany around 30% (with a downward trend). Transmission is presumed to be oral-oral or fecal-oral, mostly during childhood. Without treatment, the infection can lead to lifelong chronic-active inflammation. Relevant risk factors: lower socioeconomic status, infected family members, origin in regions with high prevalence.¹
NSAID painkillers (ibuprofen, diclofenac, aspirin/ASA)
Inhibit, among other things, the COX-1 enzyme, which is important for protecting the gastric mucosa. Risk rises with dose and duration. Combining NSAIDs with cortisone or blood thinners is considered particularly risky. Gentler alternative on the stomach in many situations: acetaminophen (paracetamol). When NSAIDs are medically necessary, a PPI is often used as gastric protection.¹
Autoimmune
The immune system attacks the parietal cells of the stomach. Rarer than H. pylori gastritis — often occurs together with other autoimmune conditions.

Other risk factors

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

5. Diagnosis: gastroscopy and H. pylori testing

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

Gastroscopy — when is it recommended?

  • Warning signs (signs of bleeding, unintended weight loss, swallowing problems)
  • First onset at an older age
  • Lack of treatment response
  • Suspicion of a stomach ulcer or a malignant change
  • Follow-up after eradication therapy in a pre-existing ulcer
Gastroscopy (gold standard)
Through a flexible endoscope, the gastric mucosa is assessed directly. Tissue samples (biopsies) for histology and a rapid urease test for H. pylori can be taken. Sedation is available on request. Important: PPIs should generally be paused for several weeks before testing for H. pylori — 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 exhaled air. Also used to confirm treatment success after eradication.¹
Stool antigen test
Detects H. pylori antigens in the stool. Easy to perform and well suited for children. Accuracy comparable to the breath test.
Blood test (antibodies)
Generally only shows whether there has ever been an infection — not whether one is currently still present. Usually not suitable for follow-up monitoring.
H. pylori test only after a PPI pause! An H. pylori test should generally only take place several weeks after stopping PPIs and several weeks after antibiotic therapy — otherwise false-negative results are possible. The exact intervals are determined by your treating doctor.

Learn more: Preparing for a doctor's appointment.

6. Medications and treatment

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

Proton pump inhibitors (PPIs) — the most important drug class

PPIs: omeprazole, pantoprazole, esomeprazole
Significantly reduce stomach acid production and so take the pressure off the inflamed mucosa.
How to take: Generally in the morning on an empty stomach, some time before breakfast
Duration: Individually determined — from a few weeks for acute gastritis to long-term therapy as gastric protection when NSAID treatment is necessary
Long-term side effects: Among others, vitamin B12 or magnesium deficiency, increased risk of certain gut infections; in older people possibly an increased risk of bone fractures³
Do not stop abruptly: On stopping, acid production can be temporarily increased (rebound effect). Slow tapering as advised by your doctor. Learn more: Stopping medication

H. pylori eradication — current first-line per the 2023 S2k guideline

Important change: clarithromycin triple therapy no longer first-line The updated S2k guideline has changed the recommendation: the previously common standard regimen (PPI + clarithromycin + amoxicillin) is no longer generally recommended in Germany as empirical first-line therapy — the background is rising clarithromycin resistance.¹˒²
Empirical first-line: bismuth quadruple therapy (new)
Regimen: PPI + bismuth + tetracycline + metronidazole for at least 10 days
Available in Germany: A fixed combination pack (3-in-1 capsule) used together with omeprazole
Advantage: Can generally be used largely independently of clarithromycin resistance
Common side effects: Nausea, metallic taste in the mouth, dark-colored stool (from bismuth — usually harmless)
Avoid alcohol during therapy!¹˒²
Alternative first-line: concomitant quadruple therapy
PPI + amoxicillin + clarithromycin + metronidazole, generally for 14 days. Considered on a case-by-case basis.
After treatment failure
Per the S2k guideline, resistance testing is recommended. Second-line therapy is then based on the resistance profile — options include fluoroquinolone-based regimens, among others. Several weeks after end of therapy: confirm success with a breath test or stool antigen test (after a PPI pause).
Complete the full eradication course! All medications should be taken until the end — even if symptoms ease earlier. Stopping prematurely can promote resistance and render the therapy ineffective. Learn more: How to take antibiotics.

Other medications

H2 receptor blockers (e.g. famotidine)
Acid suppression is generally weaker than with PPIs, but the onset is often somewhat faster. A possible option in PPI intolerance or for short-term use — after medical advice.
Antacids (e.g. Maalox, Rennie, Talcid)
Neutralize stomach acid directly. Provide quick but usually only short-term relief. They generally do not heal the inflammation — they treat symptoms.
Sucralfate
Forms a protective film over the inflamed mucosa or an ulcer. Generally taken on an empty stomach before meals — as prescribed. Learn more: Medication before or after eating.

7. Diet for gastritis — what helps, what hurts

Diet alone generally does not heal gastritis — but it can support healing and significantly relieve symptoms. What matters most is individual tolerance.

Better avoided in the acute phase
  • Alcohol — can irritate the mucosa directly
  • Coffee on an empty stomach
  • Very spicy seasonings if you know you're sensitive
  • Very fatty food (fried, breaded dishes)
  • Very acidic foods (citrus fruit)
  • Highly carbonated drinks
Generally well tolerated
  • Oatmeal (porridge) — a classic stomach-friendly choice
  • Potatoes, rice, pasta
  • Steamed vegetables (carrots, zucchini, fennel)
  • Bananas — considered easy on the stomach
  • Chamomile tea — traditionally calming for the stomach
  • Lean meat or fish, steamed
  • Yogurt if tolerated well
General dietary tips Several smaller meals instead of a few large ones · Eat slowly and chew well · Don't eat right before bed · Food neither very hot nor ice cold · A food diary can help identify individual triggers

8. Complications: stomach ulcer and gastric cancer risk

  • Stomach ulcer (gastric or duodenal ulcer): A deeper defect in the mucosa — often in connection with H. pylori or NSAIDs. Possible complications: bleeding or perforation (rupture of the stomach wall) — the latter is a medical emergency.
  • Gastric bleeding: Warning signs: tarry stool, coffee-ground-like vomit, circulatory weakness — call 112 immediately.
  • 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 gastric cancer. Eradication can generally reduce this risk, especially when carried out early. With advanced atrophy or metaplasia, regular endoscopic follow-up is often recommended.¹
  • Vitamin B12 deficiency: Can occur in type A gastritis and — in some cases — with very long-term PPI use. Possible signs: marked fatigue, pallor, tingling in the hands or feet, problems with concentration.

9. Living with gastritis

  • Stress: Considered one of the most important aggravating factors. Relaxation techniques (e.g. progressive muscle relaxation, breathing exercises, yoga), enough sleep and regular exercise generally help.
  • Painkillers: Ibuprofen, diclofenac and aspirin/ASA should be avoided where possible during active gastritis. Gentler alternative: acetaminophen (paracetamol). When NSAIDs are medically necessary, a PPI is often prescribed alongside.
  • Smoking: Can mostly worsen gastritis and delay healing. Stopping smoking generally supports recovery significantly.
  • Alcohol: Complete abstinence is often appropriate in the acute phase. Learn more: Medication and alcohol.
  • Taking PPIs: Generally in the morning on an empty stomach, some time before breakfast. Don't stop abruptly. Have the need reviewed by your doctor regularly. Learn more: Medication before or after eating.

How brite helps you with gastritis

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

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

Acute gastritis generally heals completely once the cause is removed. Chronic type B gastritis (Helicobacter pylori) is considered well treatable with eradication therapy. Type A gastritis (autoimmune) is not curable, but generally well manageable — among other things with medically supervised vitamin B12 supplementation. Type C gastritis (chemical) is mostly controllable by avoiding the triggering substance and using gastric protection.¹
Acute gastritis generally lasts a few days to a few weeks. Chronic gastritis can persist for months or years without treatment. With appropriate therapy, symptoms often improve within a few weeks. An H. pylori eradication course generally lasts around 10 to 14 days; success is usually confirmed 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 improvement, coffee in moderation and not on an empty stomach is in many cases possible again. Sometimes milk coffee is better tolerated than black coffee.
Transmission is presumed to be oral-oral or fecal-oral and mostly occurs during childhood — often within the family. Reinfection in adulthood is generally rare in industrialized countries. After successful eradication, reinfection is rather unlikely.¹
The updated S2k guideline has changed the first-line therapy: the previously common triple therapy with clarithromycin is generally no longer recommended in Germany as empirical first-line therapy — the background is rising clarithromycin resistance. The new empirical first line is generally bismuth quadruple therapy for at least 10 days (PPI + bismuth + tetracycline + metronidazole).¹˒²
That depends on the situation. For acute gastritis, a few weeks are generally enough; then a slow taper can be sensible. For necessary long-term NSAID therapy, the PPI is usually taken alongside as gastric protection. Important: the need should be reviewed by a doctor regularly — PPIs should not simply be continued long-term without good reason.³
A long-term H. pylori infection can increase the risk of gastric cancer. Eradication can generally reduce this risk — especially when carried out early. With advanced mucosal atrophy or metaplasia, regular endoscopic follow-up is often recommended. A slightly increased risk is also described in type A gastritis.¹
As a gentler alternative on the stomach, acetaminophen (paracetamol) is often used. Ibuprofen, diclofenac and aspirin/ASA should be avoided where possible during active gastritis. If NSAIDs are medically necessary, a PPI is usually prescribed alongside for gastric protection. The decision is always made by your treating doctor.
After an abrupt PPI stop, stomach acid production can be temporarily increased (a so-called rebound effect) — this can worsen symptoms in the short term. Slow tapering as advised by your doctor is therefore generally sensible. Learn more: Stopping medication.

12. Related topics

Heartburn and reflux Irritable bowel syndrome Stomach problems from medication How to take antibiotics Medication before or after eating Stopping medication Medication and alcohol Medication interactions Medication side effects

Sources

  1. S2k Guideline "Helicobacter pylori and Gastroduodenal Ulcer Disease" (DGVS, AWMF reg. no. 021-001), 2023 Update. awmf.org
  2. Fischbach W. et al.: Updated S2k Guideline on Helicobacter pylori and Gastroduodenal Ulcer Disease (Z Gastroenterol 2023; 61: 544–606). pmc.ncbi.nlm.nih.gov
  3. gesundheitsinformation.de (IQWiG): Gastritis. gesundheitsinformation.de
  4. German Society for Gastroenterology, Digestive and Metabolic Diseases (DGVS). dgvs.de
  5. Apotheken Umschau: Gastritis — Patient Information. apotheken-umschau.de
Medical disclaimer: This article is for general information only and is not a substitute for medical advice, diagnosis or treatment. The choice of medication and dosages are always determined individually by your 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. Before an H. pylori test, coordinate the necessary PPI pause with your treating practice. Last updated: April 2026.