Gastritis

If fullness, early satiety or pressure in the upper belly persist despite an unremarkable finding, the stomach is not damaged but too sensitive. There are levers of its own for that, and they work.

Helicobacter is the most common treatable cause. A breath or stool test settles it without an endoscopy — important is to take no acid blocker for two weeks beforehand, otherwise the test comes out falsely negative.

Ibuprofen, diclofenac and other anti-inflammatory drugs are the second most common cause, including low-dose acetylsalicylic acid. Anyone needing them regularly should talk about stomach protection.

Four to eight weeks is the usual frame; afterwards it is checked whether it goes on. On stopping after long use the acid briefly overshoots the old level — hence taper rather than stop abruptly.

A full meal shortly before lying down is the most common avoidable trigger of night-time trouble. Raising the head of the bed slightly costs nothing and works at once.

Black stool, vomiting blood, trouble swallowing, unintended weight loss, anaemia, first occurrence after the age of fifty: then one does not try things, one looks.

Violent pain with nausea a few hours after sushi or marinated anchovies is not gastritis. At gastroscopy the worm is seen and removed at once — that ends the complaints immediately.

Acid blockers take the acid away so the lining can heal. If Helicobacter is behind it, only eradication over seven to fourteen days removes the cause — the relapse rate then drops markedly. Without a proven organism, the acid blocker treats the symptoms, not the trigger.

Eradicating Helicobacter takes ten to fourteen days with three to four drugs at once; success is checked at the earliest four weeks after the end, otherwise the test reads falsely negative. Acid blockers heal the lining in four to eight weeks. About half the world’s population carries Helicobacter; only a small share develops an ulcer from it — the amount and the duration of colonisation help decide.

A pressure or burning in the pit of the stomach connected to eating: with a stomach ulcer rather during or shortly after, with a duodenal ulcer rather on an empty stomach and at night.

A feeling of fullness after small portions, frequent belching, nausea especially in the morning and an aversion to coffee, alcohol and spicy food.

An inflammation of the lining can stay silent for years and still lead to an ulcer. Conversely, some people with strong complaints have a completely normal lining. Complaints and findings often diverge here.

Black, sticky stool, vomit like coffee grounds, sudden weakness, pallor and a racing heart. That is an emergency — even if the stomach itself does not hurt just then.

The inflamed lining makes the stomach sensitive to stretch — fullness arrives sooner than the amount would explain.

The autoimmune form permanently impairs B12 uptake.

Taken up right at the end of the small bowel and needing a helper from the stomach. If either place is affected a deficiency arises — often only after years, because the liver holds a store.

Taken up in the upper small bowel and needing stomach acid. Acid blockers, an inflamed lining and silent blood losses often come together here.

One of the fat-soluble vitamins, lost with the fat when fat digestion is disturbed. Fatty, floating stools over months are the pointer to it.

Needs vitamin D for uptake, and with disturbed fat digestion it additionally binds to fatty acids in the bowel. So bone density and bowel disease hang together more closely than assumed.

Lost in considerable amounts with lasting diarrhoea. Signs are cracked corners of the mouth, loss of taste, poor wound healing and thinning hair.

Zinc carnosine is the best-studied preparation for the stomach lining — 75 mg a day over 8 weeks, often alongside treatment for Helicobacter.

Traditionally used for stomach complaints. As a tea before meals, several times a day; the effect is mild and lasts hours. It does not act on inflammation caused by Helicobacter.

Clearly worthwhile and well supported when deficient — vegan, older adults, certain drugs. No energy boost without a deficiency.

Clearly effective with proven deficiency, useless without. Take only with a documented deficiency — excess is harmful.

Clearly worthwhile and well studied when deficient; fewer data for the wider uses. Fat-soluble — check blood levels at high doses.

Steers the production of acid. With an inflammation that destroys the acid-forming cells it rises — and a permanently high value under acid blockers is to be expected and no alarm sign.

Stimulates the production of acid by a road of its own. That is the point at which the older acid blockers act and explains why some people react to histamine-rich food with burning.

The brake on gastrin and acid. Colonisation with Helicobacter lowers it — so acid rises there, while a stomach lining inflamed over years ends up making too little acid and then also takes up too little vitamin B12.

Alcohol, large amounts of coffee, very spicy food and smoking irritate. How much someone tolerates varies; it helps to leave them out for two weeks and then test one at a time.

An empty stomach with acid often hurts more than a full one. 5–6 small meals and the last bite 3 hours before lying down is the usual approach.

Camomile and sage are the traditional choice for irritated lining — as tea, several times a day.

Much used for stomach complaints; absorption is low without fat and pepper.

Manuka and propolis preparations are traditionally taken for irritated lining.

Mucilage lays a film over the irritated stomach lining — cold-steeped, not boiled.

Traditional for stomach cramps; in acute inflammation it is often not tolerated.

In a warm belly compress, not internally. Essential oils do not belong in an inflamed stomach — the warmth from outside is the whole contribution.

The Stomach takes in, the Spleen transforms. Complaints after eating are almost always assigned to this pair.

The most frequently needled point in the world, below the knee. For nausea and stomach complaints it is the best studied.

Fresh ginger counts as warming and stomach-calming — here the old assignment matches what is measured today for nausea. With an inflamed lining it can burn, though.

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