An Integrative Medicine Approach to Gastritis

Gastritis is a condition that involves inflammation of the lining of the stomach (the gastric mucosa). This inflammation and irritation can contribute to bloating, fatigue, and stomach pain. A functional medicine approach to gastritis looks at the underlying causes of this inflammation, such as irritating medications, infections and pathogens, food allergies and sensitivities, bacterial imbalances, and poor digestion, to address these issues using diet, lifestyle, and supplementation when appropriate.

Gastritis is a relatively common condition. Acute gastritis impacts about 8 out of every 1,000 people, while chronic, long-term gastritis affects approximately 2 out of 10,000 people.

Depending on the cause, targeted herbal and plant-based approaches can be used along with meaningful stress management practices to help to heal the stomach lining, reduce inflammation, and resolve any imbalances in the gut microbiome.

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What Causes Gastritis

When the mucus-lined barrier that protects the stomach wall becomes injured and weakened, digestive juices can damage and inflame the stomach lining. The inflammation underlying gastritis can come from numerous sources. A functional medicine approach to gastritis looks at potential underlying causes of this inflammation.

Infections

Bacterial infection with Helicobacter pylori is common worldwide and can contribute to gastritis and stomach ulcers in some people. This vulnerability to the bacterium-causing symptoms seems to be related to genetic factors along with lifestyle influences, such as smoking and diet.

Gastritis may also be caused by infections with viruses such as herpes simplex virus or cytomegalovirus, parasites, or fungus.

SIBO (Small Intestinal Bacterial Overgrowth)

Gastritis and its treatment can both influence and be influenced by the presence of pathogens and bacteria in the small intestines. When the stomach becomes inflamed with gastritis and gastric acid secretion is not ideal, gastric bacteria may translocate into the small intestine or overgrow in the stomach contributing to bacterial overgrowth (SIBO).

Emerging research also suggests that long-term treatment with acid-blocking medications like proton pump inhibitors can produce a more alkaline environment that is unfriendly to acid-tolerant Helicobacter pylori but allows for the overgrowth of other types of bacteria, including Lactobacillus, Enterobacter, Staphylococcus, and Propionibacterium.

NSAIDs

Regular use of pain relievers referred to as nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve, Anaprox DS) can reduce an important substance that helps preserve the protective lining of the stomach and lead to acute inflammation and gastritis.

Age

The stomach lining tends to thin with age, increasing the risk of developing gastritis.

Risk Factors for Gastritis

Several factors influence the risk of developing this inflammation that contributes to gastritis. These include age, biological and infectious factors, environmental influences, and individual behaviors.

Common risk factors in the development of gastritis include:

• Bacterial infection with Helicobacter pylori, which also causes stomach ulcers.
• Parasites.
• Food allergies and sensitivities.
• Bacterial overgrowth.
• Poor digestion.
• An autoimmune disorder (autoimmune gastritis) where the body's immune system mistakenly attacks the stomach lining
• Chronic excessive alcohol use and/or smoking.
• Conditions that contribute to imbalanced inflammation such as Crohn's disease, HIV/AIDS, celiac disease, and sarcoidosis
• Advancing age.
• Significant stress due to major surgery, injury, burns, or severe infections.
• A backup of bile into the stomach causing irritation.
• Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen.
• A disorder of red blood cells due to the inability to properly absorb and utilize vitamin B12 called pernicious anemia.

Gastritis Signs & Symptoms

The most common symptoms of gastritis are stomach upset and pain due to inflammation and irritation of the stomach lining.

Gastritis can also cause other symptoms, including:

• Gnawing or burning ache or pain/indigestion (dyspepsia) in the upper abdomen
• A feeling of fullness after eating
• Heartburn or acid reflux
• Hiccups
• Loss of appetite
• Nausea
• Vomiting, possibly of blood or material that looks like coffee grounds
• Dark stools from blood in the stools
• Bloating
• Fatigue
• Skin conditions and rashes
  

Over time, if the root cause of gastritis is not treated, it can lead to stomach ulcers and bleeding.

When to See a Doctor

If stomach pain or indigestion persists despite changes to diet and lifestyle, medical evaluation and intervention may be necessary. It is important to seek medical care and assessment if:

• Abdominal pain or indigestion symptoms last a week or more and cause severe pain or distress.
• Vomiting is prolonged, leading to dehydration or an inability to maintain proper nutrition or keep food down.
• There is blood or the appearance of "coffee grounds" when vomiting or your stool appears black.
• You feel light-headed or dizzy, or at risk of passing out.
• Severe stomach pain occurs after taking a new prescription or over-the-counter medication, especially pain relievers.

Complications of Gastritis

If gastritis is prolonged and does not get treated appropriately, it may lead to stomach ulcers or peptic ulcer disease. This occurs when the inflammation degrades the stomach's lining, which causes thinning and changes the cells that protect the stomach wall from stomach acid and digestion.

Another potential complication of chronic gastritis is polyps. Gastric polyps are small masses of cells that form on the inside lining of the stomach due to long-term irritation and inflammation.

In addition, chronic gastritis can contribute to atrophic gastritis. This complication develops when gastritis is caused by H. pylori bacteria or by an autoimmune disorder. Atrophic gastritis destroys the cells that line the stomach and make digestive juices and stomach acid.

Functional Medicine Labs to Test for Root Cause of Gastritis

H. Pylori

Stool or breath tests can detect the bacterium H. pylori. For example, the H. pylori Profile uses DNA-based testing, including testing for Antibiotic Resistance Genes and Virulence Factors, to help identify the symptoms that H. pylori may be contributing to and guide treatment protocols.

Comprehensive Stool Test

Unaddressed food sensitivities, a highly-processed diet, and other factors often contribute to the inflammation that causes gastritis. A Comprehensive Stool Test measures gut bacteria, inflammatory markers, leaky gut, and pathogens to assess the state of the gut and guide treatment aimed at restoring balance and calming inflammation of the stomach lining. Similarly, the GI-MAP assesses a variety of bacteria (including H. pylori), parasites, viruses, fungi/yeast, antibiotic resistance genes, and several intestinal health markers.

Food Sensitivities

Food sensitivities contribute to inflammation in the stomach and throughout the body and potential autoimmunity. ELISA testing identifies foods to which an individual is sensitive. Additional testing for gluten sensitivity or celiac disease with Genova Diagnostics Celiac and Gluten Sensitivity and evaluation of the leaky gut marker zonulin can also help uncover contributing factors to the inflammation found in gastritis.

Small Intestinal Bacterial Overgrowth (SIBO)

Since gastritis and its treatment can contribute to bacteria imbalances and lead to SIBO, a breath test can be used to evaluate the overgrowth of bacteria that do not normally belong in the small intestine. The 3-hour SIBO assessment is a non-invasive breath test that measures hydrogen and methane to evaluate bacterial overgrowth in the small intestine.

Conventional Testing

Endoscopy with biopsy

During an endoscopy, a scope with a camera is inserted into the upper digestive system through the esophagus and into the stomach and small intestine to look for signs of inflammation that can indicate gastritis. If suspicious areas are found, small tissue samples (biopsies) can be removed for laboratory examination, which can also allow for identifying the presence of H. pylori in the stomach lining.

Barium swallow or upper gastrointestinal series X-rays

This series of X-rays requires drinking a white, metallic liquid (containing barium) that coats the digestive tract to allow for a series of X-ray images of the esophagus, stomach, and small intestine.

Conventional Treatment for Gastritis

Conventional treatment for H. pylori infection that is causing gastritis often involves three medications or "triple therapy." This includes a proton pump inhibitor to reduce acid production and two antibiotics. Bismuth salicylate (Pepto Bismol) is sometimes used instead of the second antibiotic.

6 Natural Treatments for Gastritis

The treatment of gastritis depends on the specific identified underlying causes and focuses on removing any irritating factors and balancing inflammation. For example, acute gastritis caused by NSAIDs, smoking, or alcohol use may be relieved by stopping the use of those substances. Other cases of gastritis may respond to an anti-inflammatory diet, lifestyle changes, and targeted phytonutrients and supplementation to restore balance.

1. Diet and nutrition

A fiber-rich anti-inflammatory diet that eliminates any food allergens or intolerances and avoids food triggers such as alcohol, processed sugars, coffee, spicy foods, overly acidic foods, nitrates, and processed salty foods can help calm inflammation in the stomach. An individualized nutrient-rich, anti-inflammatory diet can help balance inflammation to prevent flares and further irritation to the stomach and rest of the gastrointestinal tract while optimizing nutrient levels.

2. Cabbage Juicing

Traditionally, cabbage and cabbage juice has been used to heal the stomach and prevent ulcers and gastritis. It is rich in antioxidants like vitamin C that may help prevent and treat H. pylori infections and provides the amino acid L-glutamine and the antioxidant sulforaphane that help to protect and heal the gastric lining and prevent and heal a leaky gut. Cabbage is also a rich source of methionine S-methyl sulfonium (MMS) that can help heal stomach lining irritation.

3. Increase Flavonoids

Foods containing plant compounds known as flavonoids like apples, celery, cranberries, onions, garlic, and tea may stop the growth of H. pylori, have antiviral and anti-histamine activity, and reduce inflammation to help heal gastritis. For example, the flavonoid quercetin can protect the stomach lining and prevent gastritis.

4. Rebalance the Gut

In addition to incorporating naturally probiotic-rich foods like sauerkraut and kimchi, studies have shown that certain probiotic strains of Bifidobacterium bifidum can help to inhibit H. pylori. In addition, zinc and L-carnosine may be used to reduce infection with H. pylori and prevent irritation to accelerate healing and prevent future damage. Zinc demonstrates antibacterial effects with deficiencies of zinc associated with microbial infections, intestinal inflammation, delayed wound healing, and impaired immune system function.

5. Repair the Gastric Mucosa

In addition to zinc-carnosine, various plant compounds such as deglycyrrhizinated licorice, L-glutamine, mastic gum, and aloe vera have been shown to help regenerate damaged stomach lining, stimulate mucus secretion, reduce inflammation and promote gastric healing.

6. Stress Management

When the body is under stress, digestion is not prioritized, which can lead to the under-production of stomach acid and enzymes that normally help to maintain an optional balance in the microbiome. Managing daily stress through relaxation techniques, such as yoga, tai chi, and meditation, can help rebalance the stomach environment and heal gastritis.

Summary

Gastritis is a condition that results in inflammation and irritation of the stomach lining. Many factors can contribute to the damage or weakening of the protective stomach lining, which leads to inflammation that can cause pain, nausea, bloating, and bleeding.

Some of the most common causes of gastritis include infection with the bacterium H.pylori and overuse of certain pain (NSAID) medications. In addition, a functional medicine approach to gastritis seeks to uncover and address additional potential causes of inflammation in the stomach lining, including chronic stress, alcohol overuse, and imbalances in the gut microbiome.

A variety of treatment approaches can help to eradicate H.pylori, heal the stomach lining, and reduce inflammation to heal gastritis. An anti-inflammatory with gut-healing foods like cabbage, sauerkraut, and other probiotic-rich foods, fiber, and flavonoids helps reduce inflammation and allow the stomach lining to heal. In addition, targeted herbal and plant-based approaches can be used along with a meaningful stress management practice to restore balance to the body.