Alcoholic Gastritis: Symptoms, Triggers & Treatment

Alcoholic Gastritis

Drinking alcohol in excess can damage the stomach and digestive system. The stomach is an organ that plays a vital part in the digestive system.

Food and drinks that are consumed are mixed with gastric fluids that contain hydrochloric acid (stomach acid), along with different enzymes.

Alcoholic gastritis is caused by an inflammation of the stomach lining, directly linked to chronic alcohol abuse. Alcoholic gastritis can also be caused by added infection and anti-inflammatory medication. [1]

Alcoholic gastritis can be acute gastritis, with severe attacks lasting around a day or two. It may also be chronic gastritis, presenting long-term symptoms.

There are different causes and common triggers of general gastritis:

• Medication and anti-inflammatory drugs
• Helicobacter pylori bacterial infection
• Alcohol
• Vomiting
• The overproduction of gastric fluids (often caused by stress)
• Backflow of bile
• Allergies
• Immune conditions
• Exposure to radiation
• Drugs
• Spicy foods
• Smoking
• Stress

There are two types of gastritis caused by alcohol: erosive and non-erosive. Erosive gastritis, also referred to as reactive gastritis, leads to severe inflammation and erosion of the stomach lining. Non-erosive gastritis is inflammation of the lining of the stomach, but without severe erosion or issues with the stomach lining. [2] [3]

Drinking alcohol is often associated with stomach issues. The stomach is the first point of contact for alcohol, and often where the alcohol first starts to metabolise.

Alcohol can affect the stomach’s ability to produce acid and its ability to remove bacteria that enters the stomach. This allows harmful bacteria to build up, whilst the healthy cells that line the stomach become damaged.

Once the healthy cells are damaged by acid and enzymes, the lining becomes inflamed.

It is difficult to predict how much alcohol and what types of alcohol cause alcoholic gastritis. The severity of this condition depends on the make-up of the individual involved, medical history, general health, and how long heavy drinking has gone on for.

Symptoms of Alcoholic Gastritis

Some people with alcoholic gastritis present as asymptomatic, whilst others will experience uncomfortable symptoms. The difficulty with these symptoms is that they mirror other conditions.

Common symptoms of alcoholic gastritis include:

• Burning feeling in the stomach
• Abdominal pain
• Bleeding in the stomach – appearing in vomit or stools
• Burping and passing gas
• Feeling bloated or constantly full
• Hiccups
• Loss of appetite
• Nausea and vomiting
• Severe stomach pain in the upper stomach, located under the ribs
• Constant indigestion

The lining of the stomach consists of multiple folds, called the epithelium. This is coated by a mucus called gastric mucosa and is primarily where the inflammation from alcohol abuse will occur.

Diagnosing Alcoholic Gastritis

Forty years ago, alcoholic gastritis was diagnosed on the grounds of secretion via stomach tubes. The presence of mucus was the main cause for concern, usually leading to a ‘gastric catarrh’ (chronic gastritis) diagnosis.[4]

In modern medicine, gastritis is a term used generally for uncomfortable digestive issues and symptoms. Chronic inflammation caused by alcohol was regarded as ‘rare’, but within the last few years, chronic gastritis has shown to be widespread.

This is thanks to the aid of a flexible gastroscope; gastroscopes are able to look at the throat, oesophagus (food pipe) and into stomach.

Firstly, a doctor or medical professional with give you a physical exam and discuss your medical history and personal habits. This will include alcohol, smoking and your diet, so it is best, to be honest about how much you drink and how often this is occurring.

This may be enough evidence to diagnose alcoholic gastritis, but they may suggest other tests:

1. A breath test: the breath test will look for any bacteria that might be causing gastritis. You will be given a clear liquid to drink and then you will be asked to blow into a bag. The bag is then sealed and sent off for bacterial testing in a lab, revealing whether the liquid has been broken down in your stomach or not.
2. GI system X-ray: an X-ray of the upper gastrointestinal tract may be required. This will look at the oesophagus, stomach, and parts of the small intestine (duodenum).
3. An endoscopy and biopsy: during an endoscopy, a thin and very flexible tube with a camera attached to the end is fed through the oesophagus and into the stomach. The medical professional will assess the stomach lining, and they may remove some tissue or other elements for further lab testing. This is called a biopsy, which are samples taken during testing. The physician will look to see if there is reddish gastric mucosa, which will likely lead to a diagnosis of gastritis if it is found.
4. Blood tests and stool samples: the physician will likely take your blood to look for certain bacteria that may cause gastritis or for the common signs of anaemia. They may also suggest giving a sample of your stool. This will check for specific bacteria that causes gastritis and any blood as a result of bleeding stomach or intestinal linings.

If you choose not to see a doctor when you experience the symptoms of alcoholic gastritis, this can lead to severe medical issues down the line.

Left untreated, alcoholic gastritis causes:

• Peptic ulcers: peptic ulcers are stomach ulcers, painful sores that appear in the upper part of the digestive tract. These sores can appear as gastric ulcers, on the inside of the stomach, or as duodenal ulcers, appearing on the duodenum (upper small intestine).
• Gastric polyps: clumps of cells that appear on the stomach lining. These wart-like growths can grow if left untreated and harbour cancer.
• Anaemia: Anaemia is a condition caused by a lack of healthy red blood cells. These cells are required to carry oxygenated blood around the body and to its tissues. Low haemoglobin such as this can make people feel tired and very weak.
• Stomach cancer: stomach cancer is rare in the UK but can be caused by untreated alcoholic gastritis. This can affect digestion, causing:[5]
• Heartburn
• Acid reflux
• Problems swallowing
• Nausea
• Indigestion
• Bloating or feeling full
• Loss of appetite
• Lump at the top of the stomach
• Pain at the top of the stomach
• Tiredness and weakness

Evidence has suggested that people who drink moderately and heavily are at a higher risk of cancer. Moderate drinkers (around 4 alcoholic drinks per day) have a 21% increased risk of cancer, whilst heavy drinkers (more than 4 alcoholic drinks per day) have over 50% increased risk of cancer. [6]

Treatment for Alcoholic Gastritis

Following a diagnosis of alcoholic gastritis, you will be prescribed medication. They may prescribe you proton pump inhibitors (PPIs) to help reduce the levels of acid in the stomach. PPIs work to relieve any acid or gastroesophageal reflux, whilst also treating duodenal and gastric ulcers. [7]

There are different types of PPIs:[8]

• Omeprazole
• Esomeprazole
• Lansoprazole
• Rabeprazole
• Pantoprazole
• Dexlansoprazole
• Zegerid

Professionals may also ask that you eat smaller meals but more frequently. This helps to avoid triggers that irritate you stomach. They will also ask you to stop drinking alcohol and avoid acidic foods.

If you are struggling to cut out alcohol, you make need to seek help for alcohol addiction or an alcohol use disorder. Treatment for this may come in the form of inpatient rehab, outpatient rehab, or therapy.

This may not be necessary, as intervention and education may be all you need to quit drinking. However, chronic alcohol use can lead to a host of medical issues.

Digestive acids can be overpowering and damaging, specifically when the patient engages in excessive drinking or binge drinking. Alcohol consumption dictates how severe alcoholic gastritis may be, and the more alcohol that is consumed, the worse the symptoms may be.

There are different treatment options for alcoholic gastritis, but if left untreated, it may result in a medical emergency.

There are numerous risk factors that contribute to alcoholic gastritis, but alcohol abuse is the main cause. The symptoms of gastritis mirror other conditions, so always check out constant stomach pain and other forms of discomfort.

Avoid any irritating substances and the consumption of alcohol, and aim to figure out if you are prone to diet-related triggers or emotional triggers. Do not make your symptoms worse by leaving them untreated, seek medical help now if you have symptoms of worries about alcoholic gastritis.

References

[1] https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/gastritis#bhc-content

[2] National Health Service. (2019, May 20). Gastritis.

[3] Department of Health, State Government of Victoria. (2014, August 31). Gastritis.

[4] BERRY LH. CHRONIC ALCOHOLIC GASTRITIS: EVALUATION OF THE CONCEPT, WITH GASTROSCOPIC STUDIES IN ONE HUNDRED CASES. JAMA. 1941;117(26):2233–2238. doi:10.1001/jama.1941.02820520029007

[5] https://www.nhs.uk/conditions/stomach-cancer/

[6] Vanputte, C., Seeley, R., Regan, J., Russo.,A (2011). Antamony & Physiology.., p. 902

[7] https://medlineplus.gov/ency/patientinstructions/000381.htm

[8] National Health Service. (2019, May 20). Gastritis.

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