Gastritis and gastroesophageal reflux disease (GERD) are common digestive conditions with similar discomforts, often leading to confusion. While both affect the upper digestive system and share some symptoms, they are distinct conditions. Understanding their differences is important for accurate diagnosis and effective management.
Understanding Gastritis
Gastritis involves inflammation, irritation, or erosion of the stomach lining. It can be acute (sudden and short-lived) or chronic (gradual and persistent). The stomach lining, typically robust, can become inflamed due to various factors.
Common causes include Helicobacter pylori (H. pylori) infection, a primary cause of chronic gastritis affecting up to half the global population. Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin can also irritate the stomach lining. Other factors include excessive alcohol consumption, significant physical stress from serious health problems or surgery, and certain autoimmune conditions where the immune system mistakenly attacks stomach cells.
Symptoms vary; some individuals experience none. When present, they often include upper abdominal pain (burning or gnawing, especially between meals or at night), nausea, vomiting, a feeling of fullness or bloating after eating, and loss of appetite. Severe cases may show signs of bleeding, such as black, tarry stools or blood in vomit.
Understanding GERD
Gastroesophageal reflux disease (GERD) is a chronic condition where stomach acid and contents frequently flow back into the esophagus. This reflux happens when the lower esophageal sphincter (LES), a circular muscle acting as a valve between the esophagus and stomach, doesn’t close properly or relaxes too often. A malfunctioning LES allows acidic stomach contents to irritate and damage the delicate lining of the esophagus.
Several factors contribute to GERD. Obesity increases abdominal pressure, forcing stomach contents upward and weakening the LES. A hiatal hernia, where part of the stomach pushes into the chest, can also impair LES function. Other causes include pregnancy, smoking, and certain foods and drinks (like fatty foods, chocolate, caffeine, alcohol) that relax the LES or increase stomach acid.
GERD’s characteristic symptoms primarily involve the esophagus. Heartburn, a burning chest sensation, is the most common symptom, often occurring after eating and worsening at night or when lying down. Regurgitation, where stomach contents or sour liquid return to the throat or mouth, is another frequent symptom. Individuals may also experience chest pain, difficulty swallowing, a lump sensation in the throat, chronic cough, or hoarseness from acid irritating airways.
Distinguishing Between the Conditions
While both gastritis and GERD affect the digestive system and can have overlapping symptoms like abdominal discomfort, they differ in their primary location and underlying processes. Gastritis refers to inflammation of the stomach lining.
In contrast, GERD is chronic acid reflux, primarily affecting the esophagus due to the backward flow of stomach contents. The esophagus, unlike the stomach, lacks a protective lining against strong acids, making it vulnerable to damage from frequent exposure. Therefore, the main problem in gastritis is inflammation of the stomach, while in GERD, it is the persistent irritation and potential injury to the esophageal lining from refluxed acid.
Symptoms also help differentiate them. Gastritis commonly causes upper abdominal pain or discomfort, often with nausea, vomiting, or bloating. Gastritis pain may change with eating. For GERD, the hallmark symptom is heartburn, a burning sensation in the chest or behind the breastbone, along with regurgitation. While both can cause upper abdominal pain, the specific quality and location often provide clues.
Diagnosis and Management
Diagnosing gastritis and GERD involves different approaches due to their distinct nature and affected areas. For gastritis, healthcare professionals may suspect the condition based on symptoms and medical history. Tests often identify the underlying cause, such as H. pylori infection, through breath or stool tests. An upper endoscopy, where a thin tube with a camera is inserted to visualize the esophagus, stomach, and small intestine, can show stomach lining inflammation and allow for tissue biopsies.
For GERD, diagnosis often begins with a review of symptoms, particularly recurrent heartburn and regurgitation. An upper endoscopy can assess esophageal damage, though a normal endoscopy doesn’t rule out GERD. Specialized tests like esophageal pH monitoring, which measures acid levels in the esophagus over 24 to 48 hours, are standard for confirming GERD, especially when symptoms are atypical or don’t respond to initial treatment. Esophageal manometry may also evaluate LES function and esophageal muscle movements.
Management strategies are tailored to each condition. Gastritis treatment often focuses on eliminating the cause, such as antibiotics for H. pylori infection or discontinuing NSAID use. Medications like antacids, H2 blockers, and proton pump inhibitors (PPIs) reduce stomach acid and promote healing. For GERD, lifestyle modifications are a primary intervention, including maintaining a moderate weight, avoiding trigger foods, not eating large meals close to bedtime, and elevating the head of the bed during sleep. Medications for GERD, such as antacids, H2 blockers, and PPIs, reduce acid production or neutralize stomach acid, alleviating symptoms and healing esophageal damage. In some cases, surgery may be considered for GERD if other treatments are ineffective.