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Gastritis

★ CMTO Exam Focus

Gastritis is inflammation of the gastric mucosa that can be acute (sudden onset, often erosive) or chronic (progressive, leading to mucosal atrophy). It shares many etiologic factors with peptic ulcer disease — particularly H. pylori infection and NSAID use — but differs in that the inflammation is more diffuse rather than forming discrete ulcer craters. Massage therapists should recognize gastritis because epigastric discomfort affects positioning and abdominal work, NSAID-induced gastritis is extremely common in clients who self-medicate for musculoskeletal pain, and chronic gastritis can progress to pernicious anemia with neurological consequences.

Populations and Risk Factors

  • H. pylori infection (most common cause of chronic gastritis worldwide; present in approximately 50% of the global population)
  • Chronic NSAID and aspirin use (second most common cause; highly relevant to MT clients)
  • Heavy alcohol consumption
  • Smoking
  • Physiologic stress: critical illness, burns (Curling ulcers), major surgery, head trauma (Cushing ulcers)
  • Autoimmune gastritis (associated with pernicious anemia — antibodies attack parietal cells)
  • Elderly adults (gastric mucosal atrophy increases with age)
  • Bile reflux (post-gastrectomy or post-cholecystectomy)

Causes and Pathophysiology

  • Acute gastritis: Sudden mucosal inflammation from NSAIDs, alcohol, physiologic stress, or corrosive ingestion. NSAIDs inhibit cyclooxygenase-1 (COX-1), depleting prostaglandins that maintain mucosal blood flow, mucus secretion, and bicarbonate production. This leaves the mucosa vulnerable to acid digestion, resulting in erosions and potential hemorrhage.
  • Chronic non-atrophic gastritis (Type B): H. pylori-mediated. Predominantly affects the gastric antrum. The bacterium produces urease (creating an alkaline microenvironment for survival) and triggers chronic inflammatory cascades. This form is a risk factor for duodenal ulcer and gastric adenocarcinoma.
  • Chronic atrophic gastritis (Type A — autoimmune): Antibodies target parietal cells and intrinsic factor in the gastric fundus and body. Parietal cell destruction leads to achlorhydria (absent acid production) and loss of intrinsic factor, causing pernicious anemia (vitamin B12 malabsorption). B12 deficiency produces megaloblastic anemia and potentially irreversible neurological damage (subacute combined degeneration of the spinal cord).
  • Metaplasia-dysplasia sequence: Chronic H. pylori gastritis can progress through intestinal metaplasia to dysplasia to gastric adenocarcinoma over decades (the Correa cascade).

Signs and Symptoms

  • Epigastric pain or burning (dyspepsia) — the most common symptom
  • Nausea, vomiting, early satiety, bloating
  • Anorexia and unintentional weight loss (chronic gastritis)
  • Hematemesis or melena in erosive gastritis (upper GI hemorrhage)
  • Postprandial discomfort (worsens after eating)
  • Autoimmune gastritis: Symptoms of B12 deficiency — profound fatigue, glossitis (smooth red tongue), peripheral neuropathy (numbness, tingling, gait unsteadiness), megaloblastic anemia
  • Many cases of chronic gastritis are asymptomatic and diagnosed incidentally

Red Flags

  • Hematemesis or melena: Active upper GI hemorrhage — emergency referral; do not treat
  • Progressive neurological symptoms (numbness, tingling, gait ataxia) with chronic gastritis — suggests pernicious anemia with B12 deficiency. Urgent medical referral
  • Unexplained weight loss with persistent dyspepsia — may indicate progression to gastric malignancy. Refer for endoscopic evaluation
  • Severe epigastric pain with signs of shock (tachycardia, pallor, hypotension) — GI hemorrhage. Call 911

MT Considerations

  • Relaxation massage is beneficial: Parasympathetic activation supports healing through stress reduction and may reduce acid secretion. Particularly indicated for stress-related gastritis.
  • Deep epigastric pressure: Contraindicated during active symptoms — avoid deep abdominal work over the epigastric region
  • Positioning: Prone positioning may be uncomfortable during active symptoms (pressure on epigastrium). Use side-lying or semi-reclined
  • Session timing: Schedule sessions away from meals to minimize postprandial discomfort
  • Pernicious anemia with peripheral neuropathy: If present, reduce pressure on extremities and do not rely on client feedback for pressure tolerance in affected areas (impaired sensation)
  • NSAID relevance: Many MT clients self-medicate with NSAIDs for musculoskeletal pain. Clients on chronic NSAIDs who report epigastric symptoms should be encouraged to discuss gastroprotection with their physician.
  • Medications: PPIs (omeprazole, lansoprazole) are first-line treatment. Long-term PPI use may affect calcium and iron absorption. Autoimmune gastritis requires lifelong B12 injections.

CMTO Exam Relevance

  • Category: A7 Systemic Conditions — Digestive
  • Recognize that autoimmune gastritis causes pernicious anemia (B12 deficiency with neurological consequences including peripheral neuropathy and subacute combined degeneration)
  • NSAID-related gastritis is extremely relevant to MT clients who self-medicate for pain
  • Differentiate gastritis (diffuse mucosal inflammation) from peptic ulcer disease (discrete ulcer craters)
  • Type A (autoimmune, fundus/body) vs. Type B (H. pylori, antrum) distinction
  • Hematemesis and melena are emergency red flags for erosive gastritis

Key Takeaways

  • Gastritis is gastric mucosal inflammation most commonly caused by H. pylori infection and chronic NSAID use
  • Autoimmune gastritis destroys parietal cells, causing pernicious anemia (B12 deficiency with neurological consequences)
  • Deep epigastric pressure is contraindicated during active symptoms. Prone positioning may be uncomfortable
  • NSAID-induced gastritis is highly relevant to MT clients who self-medicate for musculoskeletal pain
  • Relaxation massage supports healing through parasympathetic activation and stress reduction
  • Hematemesis or melena indicates GI hemorrhage — emergency referral

Related Conditions

Sources

  • Werner, R. (2019). A massage therapist's guide to pathology (7th ed.). Books of Discovery.
  • Norris, T. L. (2019). Porth's essentials of pathophysiology (5th ed.). Wolters Kluwer.
  • Tortora, G. J., & Derrickson, B. H. (2021). Principles of anatomy and physiology (16th ed.). Wiley.
  • Rattray, F., & Ludwig, L. (2000). Clinical massage therapy: Understanding, assessing and treating over 70 conditions. Talus Incorporated.
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