Erythematous mucosa is a medical finding often noted during an upper endoscopy. It describes the stomach’s inner lining as red and irritated, which is a sign of underlying inflammation, or gastritis. This visual finding is not a specific disease, but a common, non-specific sign that irritation is present within the gastric environment. It serves as a starting point for physicians to investigate the cause of the stomach distress.
Defining Gastric Erythema
Erythema signifies increased blood flow to a specific area, which is the body’s natural response to inflammation. The stomach lining, or mucosa, becomes hyperemic (engorged with blood) as inflammatory cells rush to the site of irritation. This process changes the normal pale-pink color of the healthy stomach wall to a noticeable red.
The location and pattern of this redness provide initial clues about the underlying cause. Erythema can be localized to a specific region, such as the antrum (the lower section closest to the small intestine), which is a common site for chronic inflammation. Alternatively, the redness may be diffuse, affecting the stomach body and fundus (the upper and middle sections). The visual characteristics of the inflamed mucosa, including whether it is flat, raised, or has erosions, help guide the subsequent investigation.
Primary Causes of Mucosal Redness
The redness in the stomach lining results from the immune system reacting to injury or infection. The most prevalent cause of chronic gastric inflammation globally is infection with the bacterium Helicobacter pylori (H. pylori). This organism colonizes the stomach lining and triggers a sustained inflammatory response, leading to chronic gastritis.
The bacteria produce enzymes that weaken the protective mucus layer and release toxins that damage mucosal cells. Prolonged H. pylori infection often begins in the antrum before potentially spreading. The resulting chronic inflammation is a significant factor in the development of peptic ulcers and long-term changes to the stomach lining.
A second major category of causes is chemical or drug-induced injury, primarily from Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) like ibuprofen or aspirin. These medications inhibit cyclooxygenase enzymes, which are necessary for producing protective prostaglandins in the stomach lining. This lack of protective compounds makes the mucosa vulnerable to damage from stomach acid, leading to patchy redness and sometimes erosions.
Excessive alcohol consumption and chronic bile reflux are also chemical injuries. Alcohol directly irritates the stomach lining, while bile can back up from the small intestine, causing chemical burn. These irritants strip away the mucus barrier, allowing stomach acid to penetrate deeper layers and cause erythema.
Less common causes involve the immune system, known as immune-mediated gastritis. Autoimmune gastritis occurs when the body mistakenly attacks the parietal cells that produce acid and intrinsic factor. This attack leads to inflammation, typically in the stomach body and fundus, and is frequently associated with pernicious anemia due to vitamin B12 deficiency. Inflammatory bowel diseases, such as Crohn’s disease, can also occasionally involve the stomach, leading to inflammation and redness.
Identifying the Underlying Condition
Identifying the specific cause of erythematous mucosa requires a diagnostic process. To confirm the underlying condition, the physician typically performs a biopsy during the endoscopy.
The biopsy involves taking small tissue samples from the inflamed areas, often from both the antrum and the body of the stomach, for histopathological analysis. A pathologist examines these samples under a microscope to confirm gastritis, determine its severity, and look for specific signs, such as H. pylori bacteria or changes consistent with autoimmune processes. This detailed tissue analysis converts the visual sign of erythema into a confirmed diagnosis of gastritis and its type.
If H. pylori is suspected, non-invasive tests can also confirm the infection. The urea breath test detects carbon dioxide produced by the bacteria, and the stool antigen test looks for bacterial proteins in the stool. These tests provide definitive evidence of an active infection and are used both for initial diagnosis and to confirm eradication after treatment.
Targeted Management Strategies
Management of erythematous mucosa depends entirely on treating the confirmed underlying cause. For an H. pylori infection, the standard approach is triple or quadruple therapy. This typically includes two or three antibiotics combined with a proton pump inhibitor (PPI). The PPI reduces stomach acid production, which helps the inflamed mucosa heal and improves antibiotic effectiveness.
When the cause is drug-induced, such as from chronic NSAID use, management involves stopping or switching the offending medication. Acid-suppressing drugs, particularly PPIs, are prescribed to minimize acid exposure, allowing the mucosa to repair itself. For inflammation due to bile reflux, medications that bind bile acids or surgical intervention may be considered to prevent further chemical injury.
Addressing lifestyle factors is also a component of the management strategy. Patients are advised to reduce or eliminate alcohol consumption, which is a direct mucosal irritant. Dietary modifications, such as avoiding foods that increase acid secretion or cause irritation, can also support the healing process.