Most patients with acute gastritis experience mild symptoms (such as upper abdominal discomfort or dull pain), remain asymptomatic, or have symptoms masked by underlying conditions. Clinically significant acute upper gastrointestinal bleeding rarely occurs in these cases.
Patients presenting at hospitals typically do so due to sudden upper gastrointestinal bleeding manifested as hematemesis and/or melena, often indicating acute erosive hemorrhagic gastritis.
Classification of Acute Gastritis
① Acute Erosive-Hemorrhagic Gastritis.An acute gastric mucosal lesion characterized by multiple erosions on the gastric mucosa, often accompanied by mucosal hemorrhage and transient shallow ulcer formation. Due to minimal or absent mucosal inflammation, it should strictly be termed acute erosive-hemorrhagic gastropathy.
② Acute gastritis caused by Helicobacter pylori (H. pylori) infection. Clinically, diagnosing acute gastritis due to H. pylori infection is challenging because transient upper abdominal symptoms often go unnoticed by patients, endoscopy is rarely indicated, and most patients present with mild or no symptoms.If left untreated, H. pylori infection can persist long-term and progress to chronic gastritis.
③ Acute gastritis caused by pathogens other than H. pylori and/or their toxins damaging the gastric mucosa. Acute gastroenteritis resulting from ingesting contaminated food tainted by microorganisms and/or their toxins primarily involves intestinal inflammation.Due to the potent antibacterial action of gastric acid, bacteria other than Helicobacter pylori rarely survive in the stomach to infect the gastric mucosa. Therefore, infectious gastritis caused by pathogens other than Helicobacter pylori is uncommon in the general population. However, when the body's immunity is compromised, acute infectious gastritis caused by various bacteria, fungi, or viruses may occur.
Dietary Considerations
1. Avoid irregular eating patterns: While a bland diet that minimizes gastric mucosal irritation is generally recommended for gastritis, blandness alone does not necessarily alleviate symptoms. The key principles are regularity, avoiding excessive hunger or fullness, and eating smaller, more frequent meals. This is especially important for the elderly, frail, or those with reduced gastrointestinal function, who benefit from 4–5 meals daily, each eaten until about 60–70% full.Pay attention to the ratio of carbohydrates, fats, and proteins in food, and ensure adequate intake of essential nutrients like vitamins.
2. Avoid tobacco, alcohol, and pungent/spicy foods: Ethanol dissolves the lipid layer of the gastric mucosal epithelium, causing significant damage. When smoking, harmful substances in tobacco smoke dissolve and adhere to the oral cavity and pharynx, entering the stomach via swallowing. These substances also severely damage the gastric mucosa.Therefore, patients with acute or chronic gastritis must abstain from tobacco and alcohol to prevent exacerbating the condition or even causing malignant changes. Foods or beverages such as chili peppers, mustard, pepper, strong tea, coffee, and cocoa irritate the gastric mucosa, causing mucosal congestion and worsening inflammation. These should also be avoided.
3. Avoid extremely cold, hot, or hard foods: Consuming excessively cold foods and beverages can trigger gastric spasms, causing vasoconstriction in the gastric mucosa and hindering inflammation resolution. Conversely, extremely hot foods and beverages may directly burn or irritate the gastric mucosa.Foods for gastritis patients should be of moderate softness. Excessively hard or coarse foods, high-fiber vegetables, and fried or grilled items increase the mechanical burden on gastric digestion. They can cause friction and damage to the gastric mucosa, worsening inflammatory lesions.