What are gastritis and gastric ulcers?
Gastritis is an inflammation of the stomach lining that can manifest in acute or chronic forms. A gastric ulcer is a deeper injury to the mucosa, penetrating into the submucosal layer. Both conditions can cause a wide range of symptoms, including upper abdominal pain, heartburn, nausea, vomiting, loss of appetite, and, in some cases, bleeding. One of the most common and significant causes of these diseases is an infection caused by the bacterium Helicobacter pylori [1, 6].
The key role of Helicobacter pylori in pathogenesis
The bacterium Helicobacter pylori (H. pylori) is recognized as the primary etiological factor for chronic gastritis and peptic ulcer disease of the stomach and duodenum. It is capable of colonizing the stomach lining, causing chronic inflammation, which over time can lead to mucosal atrophy, intestinal metaplasia, and even increase the risk of developing gastric cancer [1, 6].
Studies show that the presence of certain virulence factors in H. pylori, such as the CagA gene, may be associated with a more aggressive course of the disease and serious consequences. For example, in patients with confirmed H. pylori infection, especially in the presence of CagA, a precancerous condition — gastric intestinal metaplasia (GIM) — is more frequently detected [6]. Moreover, there is data indicating a link between H. pylori infection (particularly with strains expressing CagA) and the development of autoimmune thyroid diseases, such as Graves' disease and Hashimoto's thyroiditis [6]. This highlights not only the local but also the potential systemic influence of the bacterium on the body, making its timely diagnosis and eradication critical.
Modern approaches to the diagnosis and eradication of H. pylori
In recent years, significant progress has been made in the diagnosis and treatment of gastrointestinal problems, including H. pylori infection, especially in pediatric gastroenterology [1]. Accurate and timely diagnosis of H. pylori is a fundamental step in preventing disease progression and the development of serious complications. Diagnostic methods include invasive (biopsy with histological examination, rapid urease test) and non-invasive (urea breath test, H. pylori stool antigen test, serological tests) methods.
Treatment of H. pylori infection, known as eradication therapy, is usually a comprehensive course aimed at the complete elimination of the bacterium. Standard treatment regimens include a combination of two or three antibiotics with a drug that reduces stomach acid (a proton pump inhibitor). The choice of a specific treatment regimen is determined by many factors, including the regional prevalence of H. pylori antibiotic resistance, the patient's allergic history, and previous eradication attempts. Successful eradication of H. pylori not only significantly reduces the risk of gastritis and ulcer recurrence but is also an important measure for preventing the development of gastric cancer.
Personalized approach and comprehensive patient management
Although H. pylori infection is the primary cause of many cases of gastritis and gastric ulcers, effective treatment requires a comprehensive and personalized approach. This means that therapy should be maximally adapted to the specific patient, taking into account their individual characteristics, comorbidities, lifestyle, and response to treatment [7].
The principles of personalized, proactive, and patient-centered care, which are actively being implemented in the treatment of inflammatory bowel disease (IBD), are also applicable to other chronic gastroenterological conditions [7]. Such an approach includes not only medication but also recommendations on diet, lifestyle modifications, stress management, and the cessation of harmful habits (e.g., smoking and excessive alcohol consumption), which can exacerbate the course of gastritis and ulcers. Despite the availability of highly effective drugs, there are certain barriers to their timely and optimal prescription, such as concerns from patients and doctors regarding potential side effects or the difficulty of navigating the healthcare system [7]. Therefore, it is crucial to optimize the use of already available therapies to ensure the best outcomes for patients and prevent the development of complications [7].
Prevention of recurrence and long-term monitoring
Prevention of gastritis and ulcer recurrence, especially after successful H. pylori eradication, is the cornerstone of long-term patient management. This includes not only maintaining a healthy lifestyle but also regular medical monitoring, especially for those who have been identified with precancerous changes, such as intestinal metaplasia [6].
The continuous development of new drugs and the optimization of existing therapies allow doctors to more effectively heal the stomach lining and prevent the development of serious complications [7]. Early identification of patients at high risk of disease progression and the use of more aggressive but justified treatment strategies can significantly improve long-term prognoses and quality of life [7].
Sources
- Recent advances in pediatric gastroenterology. (Archives of disease in childhood, 2015)
- Inflammatory bowel disease and hepatitis B and C in the Western Balkans: a referral center study and literature review. (Journal of Crohn's & colitis, 2010)
- AGA Clinical Practice Update on the Inpatient Management of Adults With Inflammatory Bowel Disease: Expert Review. (Gastroenterology, 2026)
- AGA Technical Review on the Management of Mild-to-Moderate Ulcerative Colitis. (Gastroenterology, 2019)
- Prevention of gastrointestinal side effects in pediatric oncology: what are the recommendations? (Current opinion in supportive and palliative care, 2017)
- Association between autoimmune thyroid diseases and the presence of CagA and gastric intestinal metaplasia in H. pylori patients: a cross-sectional endoscopic study. (BMC endocrine disorders, 2026)
- Reframing IBD Care: A Personalized, Proactive, and Patient-Centered Approach. (The American journal of gastroenterology, 2018)
- Hepatitis C virus and inflammatory bowel disease. (Digestive diseases and sciences, 2009)
Disclaimer: The information provided in this article is for reference purposes only and should not be used for self-diagnosis or self-treatment. Always consult a qualified physician for an accurate diagnosis and an individual treatment plan.