Erosive Gastritis: Symptoms, Types, Causes and Treatment

Erosive gastritis is a condition that affects the lining of the stomach, leading to visible erosions or shallow ulcers in the mucosa. Unlike other forms of gastritis, erosive gastritis can result in bleeding and more pronounced symptoms. Understanding its symptoms, types, causes, and available treatments is crucial for effective management and improving quality of life. This article provides a comprehensive, evidence-based overview of erosive gastritis, drawing from up-to-date clinical research and expert consensus.

Symptoms of Erosive Gastritis

Erosive gastritis often presents with a range of gastrointestinal symptoms that can significantly impact daily life. While some people may experience only mild discomfort, others may face severe complications such as gastrointestinal bleeding. Recognizing these symptoms early is vital for prompt diagnosis and management.

Symptom	Description	Frequency/Prevalence	Source(s)
Epigastric Pain	Pain or discomfort in the upper abdomen	Most common	3 4 5 8
Dyspepsia	Indigestion, bloating, nausea, fullness	Very frequent (up to 83.7%)	1 3 4 5 8
Hemorrhage	Vomiting blood (hematemesis), melena	23.7%–75% in some series	3 10 15
Anorexia/Weight Loss	Loss of appetite, unintentional weight loss	Noted in several cases	5 8
Regurgitation	Acidic or bitter fluid in throat/mouth	Occasionally reported	2
Dry Cough	Associated with reflux symptoms	Occasionally reported	2

Table 1: Key Symptoms

Understanding the Symptom Spectrum

Epigastric Pain

Epigastric pain—felt in the upper central region of the abdomen—is the hallmark symptom of erosive gastritis. Studies indicate that over 90% of patients report pain, which may be persistent or intermittent and often mimics peptic ulcer disease 3 4 5 8. Sometimes, the pain is the only symptom, highlighting the importance of considering erosive gastritis in patients with unexplained upper abdominal discomfort.

Dyspeptic Symptoms

Dyspepsia is a broad term encompassing indigestion, bloating, nausea, and a sensation of fullness. Up to 83.7% of patients with erosive gastritis experience these symptoms, which can overlap with those of many other gastrointestinal conditions 1 3. Nausea and bloating are especially common, and some patients may also experience regurgitation 2.

Hemorrhagic Manifestations

One of the more severe features of erosive gastritis is gastrointestinal bleeding. This can manifest as vomiting blood (hematemesis) or black, tarry stools (melena). While bleeding occurs in less than a quarter of patients in some series, in others, especially those with severe disease, the rate can be higher 3 10 15. Hemorrhage is a medical emergency and often prompts urgent evaluation.

Other Symptoms

• Anorexia and Weight Loss: Some individuals may lose their appetite or experience unintentional weight loss, particularly when the condition persists or is associated with other complications 5 8.
• Dry Cough and Regurgitation: Rarely, patients may report a dry cough or regurgitation, which are often related to reflux of gastric contents 2.
• Asymptomatic Cases: A minority of patients may have erosive gastritis detected incidentally during endoscopy for unrelated reasons 5 8.

Types of Erosive Gastritis

Erosive gastritis is not a single entity, but rather encompasses several distinct types, each with its own clinical features, causes, and pathological findings. Differentiating these types helps guide diagnosis, management, and prognosis.

Type	Key Features	Reversibility	Source(s)
Acute Erosive	Sudden onset, often due to drugs, stress, trauma	Usually reversible	6 7 10 15
Chronic Erosive	Persistent, nodular or verrucous lesions	May be irreversible	1 4 5 6 8
Mature Type	Fibrosis-based mucosal elevation	Irreversible	6
Immature Type	Edema-based mucosal elevation	Reversible	6
Hemorrhagic	Prominent bleeding, often drug-induced	Variable	10 15

Table 2: Types of Erosive Gastritis

Acute vs. Chronic Erosive Gastritis

Acute Erosive Gastritis

Acute erosive gastritis is characterized by the rapid development of erosions in response to a direct insult. Common triggers include nonsteroidal anti-inflammatory drugs (NSAIDs), alcohol, severe physiological stress (such as trauma or sepsis), and certain medications 7 10 15. The onset is abrupt, and symptoms may include sudden pain and bleeding. With prompt removal of the causative factor and appropriate treatment, the mucosal damage is often reversible.

Chronic Erosive Gastritis

Chronic erosive gastritis develops over weeks to months and features persistent mucosal injury. Endoscopic and radiologic findings reveal nodular or verrucous lesions, sometimes described as “target lesions,” often with central erosions surrounded by elevated mucosa 1 4 5 8. Chronic forms are more likely to be seen in association with peptic ulcer disease and may not fully resolve even with treatment, especially if fibrosis is present.

Mature and Immature Types

Pathologists further classify erosive gastritis based on the nature of the mucosal elevation:

• Mature Type: The mucosal elevation is due to fibrosis and is largely irreversible, reflecting chronic injury 6.
• Immature Type: Here, the elevation is due to edema and is potentially reversible with effective therapy 6.

Repeated endoscopic evaluation may be required to distinguish between these types.

Hemorrhagic Erosive Gastritis

This type is defined by prominent bleeding from erosions and is often associated with drug use (especially aspirin and NSAIDs), severe stress, or underlying coagulopathy 10 15. Prompt recognition is critical due to the risk of significant blood loss.

Causes of Erosive Gastritis

Understanding the underlying causes of erosive gastritis is crucial for both prevention and targeted therapy. The condition arises from a complex interplay of factors that compromise the gastric mucosal barrier and promote inflammation and erosion.

Cause/Factor	Description	Typical Association	Source(s)
Drugs (NSAIDs, Aspirin, Antibiotics)	Direct mucosal injury, especially with chronic use	Acute/Chronic	3 7 10 11 15
Alcohol	Irritant effect on gastric lining	Acute	3 7
Stress/Trauma	Physiological stress, sepsis, burns	Acute	7 10 15
Bile Reflux	Toxic effect of bile acids on mucosa	Chronic	3
Dietetic Errors	Poor diet, irregular eating habits	Chronic	3
Autoimmune & Allergic Factors	Rare, possible role in select cases	Chronic	6 9
Acid/Pepsin Excess	Increases mucosal vulnerability	Both	9
Bowel Prep Solutions	Certain oral sulfate tablets (OST)	Acute	11
Idiopathic	No identifiable cause	Both	1 5 10

Table 3: Main Causes

Drug-Induced Erosive Gastritis

Among the most common causes are medications that directly damage the gastric lining or disrupt its protective mechanisms:

• NSAIDs and Aspirin: These drugs inhibit prostaglandin synthesis, reducing mucous production and impairing mucosal repair. They are the leading cause of both acute and chronic erosive gastritis 3 7 10 15.
• Other Drugs: Some antibiotics (e.g., broad-spectrum agents), as well as certain bowel prep solutions containing oral sulfate tablets, have been implicated 3 11.

Alcohol, Stress, and Trauma

• Alcohol: Its irritant properties can rapidly injure the gastric mucosa, resulting in erosive changes 3 7.
• Stress and Trauma: Severe physical stressors—including major surgery, trauma, burns, or sepsis—can precipitate acute erosive gastritis, sometimes leading to significant bleeding 7 10 15.

Bile Reflux and Diet

• Bile Reflux: When bile flows backward from the duodenum into the stomach, it has a toxic effect on the antral mucosa, contributing to chronic erosive changes 3.
• Dietetic Errors: Irregular eating habits and poor diet can predispose to chronic gastritis by disrupting mucosal defenses 3.

Acid, Pepsin, and Mucosal Barrier Defects

• Excess Gastric Acid and Pepsin: These digestive factors are necessary for the development of erosive lesions, especially when the mucosal barrier is compromised 9.
• Impaired Mucosal Defense: Factors like reduced blood flow, tissue acidosis, and defects in epithelial restitution increase vulnerability 9.

Other and Idiopathic Causes

• Autoimmune and Allergic Mechanisms: While rare, these may play a role in select patients 6 9.
• Idiopathic Cases: In a significant proportion of patients, no clear cause is found despite extensive evaluation 1 5 10.

Treatment of Erosive Gastritis

The management of erosive gastritis centers on removing causative factors, promoting mucosal healing, and alleviating symptoms. Both pharmacologic and non-pharmacologic interventions are available, with new therapies emerging from ongoing research.

Treatment	Mechanism/Approach	Efficacy/Safety Highlights	Source(s)
Drug Withdrawal	Stop offending drug (NSAIDs, alcohol, etc.)	Essential first step	3 15
Diet Modification	Bland, non-irritating diet	Supports healing	3
Antacids	Neutralize gastric acid	Symptom relief, mucosal healing	5 8
H2-Blockers	Reduce acid secretion	Clinical and endoscopic improvement	4 8
Proton Pump Inhibitors (PPIs)	Potent acid suppression	Mainstay for severe cases	13 16
Gastroprotectives (e.g., Almagel, licorice, rebamipide, DA-9601)	Mucosal protection, healing	High efficacy, good safety	3 12 16
Prostaglandin Analogs (Misoprostol)	Enhance mucosal defense	Significant symptom and lesion improvement	13
Novel Therapies (SMF exposure)	Experimental, symptom reduction	Promising in pilot studies	2
Surgery (Vagotomy, Pyloroplasty)	Control of life-threatening bleeding	Reserved for refractory cases	14 15

Table 4: Treatment Options

Initial and Supportive Measures

Removing Offending Agents

The first and most crucial intervention is to stop any drugs, alcohol, or other agents known to damage the gastric lining. This alone may be sufficient to induce healing in mild cases 3 15.

Dietary Management

A bland, non-irritating diet can support the healing process and minimize symptoms. Patients are advised to avoid spicy, acidic, or very hot foods 3.

Pharmacological Treatments

Acid Suppression

• Antacids: Provide rapid symptom relief and promote mucosal healing but may not address the underlying cause 5 8.
• H2-Blockers (e.g., cimetidine): Reduce gastric acid secretion; clinical and endoscopic improvement has been documented 4 8.
• Proton Pump Inhibitors (PPIs): Offer potent acid suppression and are considered the mainstay for moderate to severe cases, including those with bleeding 13 16.

Gastroprotective Agents

• Almagel, Deglycyrrhized Licorice: These agents coat the stomach lining and protect against further injury. Studies show a 75% healing rate after three weeks of treatment 3.
• Rebamipide: Both standard (MucostaⓇ) and new formulations (AD-203) are effective and well tolerated, with similar efficacy in improving erosions and symptoms 16.
• DA-9601: A herbal preparation that demonstrated superior efficacy compared to cetraxate in endoscopic cure rates, with an excellent safety profile 12.

Prostaglandin Analogs

• Misoprostol: Enhances mucosal defenses and is particularly useful in NSAID-induced cases. Controlled trials show significant improvement in symptoms, endoscopic appearance, and histology 13.

Emerging and Alternative Therapies

• Static Magnetic Field (SMF) Exposure: Pilot studies suggest that local SMF application may reduce symptoms by over 50% compared to sham treatment, especially where conventional options are limited or contraindicated 2.

Surgical Management

• Vagotomy and Pyloroplasty: In cases of severe, life-threatening hemorrhage unresponsive to medical therapy, surgery may be required. Procedures aim to control bleeding and reduce acid secretion 14 15. Surgery carries significant risks and is reserved for the most severe cases.

Monitoring and Follow-up

• Repeat endoscopy is often necessary to confirm healing, especially in chronic or severe cases 3 4 8.
• Ongoing symptom monitoring and avoidance of known triggers are key to preventing relapse.

Conclusion

Erosive gastritis is a multifaceted condition with a broad spectrum of symptoms, underlying causes, and treatment strategies. Early recognition and a tailored approach are essential for optimal outcomes.

Key takeaways:

• Symptoms range from mild dyspepsia to severe pain and gastrointestinal bleeding; epigastric pain is most common.
• Types include acute, chronic, mature, immature, and hemorrhagic forms, each with distinct features.
• Causes are diverse—medications (especially NSAIDs), alcohol, stress, bile reflux, and dietary habits are major contributors.
• Treatment should focus first on removing offending agents, with acid suppression, gastroprotective drugs, and, in select cases, novel therapies or surgery as needed.

By understanding erosive gastritis in depth, patients and healthcare providers can work together to effectively manage this potentially serious digestive disorder.