Acute gastritis
Also known as: acute gastritis, acute gastric mucosal inflammation, erosive gastritis, acute gastropathy, acute dyspepsia
Acute gastritis is a sudden inflammation of the stomach lining. Acute gastropathy causes mucosal injury with little or no inflammation but may produce similar symptoms. Presentations may include epigastric pain or burning, nausea, vomiting, early satiety, postprandial fullness, reduced appetite and occasionally gastrointestinal bleeding. Causes include Helicobacter pylori infection, non-steroidal anti-inflammatory drugs, alcohol, severe physiological stress, infection, bile reflux and other chemical or medication-related irritation. TCM management commonly differentiates Cold invading the Stomach, Food Stagnation, Liver Qì invading the Stomach, Damp-Heat in the middle jiao, Stomach Fire or acute injury progressing to Blood stasis. Acupuncture and Chinese herbal medicine are adjunctive and must not delay investigation or treatment of gastrointestinal bleeding, perforation, severe dehydration, acute coronary syndrome, pancreatitis, biliary disease or another serious cause of upper abdominal pain.
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Lifestyle & Diet
- •Avoid alcohol until symptoms have resolved and the underlying cause has been assessed.
- •Review NSAID, aspirin and other medication use with the prescribing clinician; do not advise abrupt cessation when the medicine has been prescribed for an important indication.
- •Use smaller, simple meals according to tolerance and avoid personally aggravating foods during the acute episode.
- •Avoid smoking and vaping because they may worsen upper gastrointestinal irritation and delay mucosal recovery.
- •Maintain fluids in small, frequent amounts when nauseated; seek medical care if fluids cannot be retained.
- •Do not use coffee, energy drinks or highly caffeinated beverages when they clearly aggravate symptoms.
- •Avoid lying flat immediately after eating where reflux or regurgitation accompanies the presentation.
- •Helicobacter pylori infection requires appropriate testing and, when confirmed, prescribed eradication therapy rather than herbal treatment alone.
- •Do not self-treat persistent symptoms indefinitely with antacids, proton-pump inhibitors, herbs or restrictive diets without determining the cause.
- •Resume normal dietary variety gradually as symptoms improve rather than maintaining unnecessarily restrictive diets.
Cautions & Contraindications
- •Do not manage haematemesis, coffee-ground vomiting, melaena, severe anaemia symptoms or haemodynamic instability with acupuncture or herbal medicine alone.[]
- •Do not delay emergency evaluation of severe, sudden or rigid-abdomen pain.[,]
- •Do not advise discontinuation of prescribed antiplatelet, anticoagulant, corticosteroid, NSAID or acid-suppressing medicine without the prescriber's involvement.[,]
- •Avoid blood-invigorating herbs during active bleeding, pregnancy or clinically significant bleeding risk unless specifically assessed by an appropriately qualified practitioner.[]
- •Avoid strong warming formulas in Stomach Fire, Damp-Heat, thirst, haematemesis or a red tongue with yellow coating.[,,]
- •Avoid strong bitter-cold formulas in Cold invasion, marked Spleen-Stomach deficiency or prolonged use without reassessment.[,]
- •Bàn Xià must be correctly processed and supplied through legally compliant channels.[,]
- •Do not use formulas containing prohibited, contaminated, incorrectly identified or toxic herbal substances.[]
- •Screen every herbal prescription for pregnancy, breastfeeding, allergies, hepatic or renal impairment and interactions with anticoagulants, antiplatelets, acid-suppressing medicines, antibiotics and other prescribed drugs.[]
- •Do not assume recurrent upper abdominal pain is functional or stress-related without appropriate investigation.[,]
- •Avoid forceful abdominal massage, cupping or deep needling when ulceration, bleeding, inflammation or acute abdominal pathology is suspected.[]
- •Do not induce vomiting after caustic, toxic or unknown substance ingestion.[,]
When to reassess or seek care again
- •Reassess after 1–2 weeks of dietary change and any acid-suppression trial; if dyspepsia persists, test for H. pylori.[,]
- •Urgent review at any point for haematemesis, melaena, unintentional weight loss, dysphagia, or persistent vomiting — refer for endoscopy.[,]
- •Retest for H. pylori eradication 4–8 weeks after completing therapy (off PPI ≥2 weeks).[]
- •NSAIDs, aspirin, alcohol, and smoking.[,]
- •Irregular meals, excessive raw/cold or spicy/greasy foods, and overeating.[,]
- •Emotional stress and anger (Liver qi invading Stomach).[]
Frequently Asked Questions
What are the main TCM patterns associated with acute gastritis?+
Common patterns include Cold invading the Stomach, Food Stagnation, Liver Qì invading the Stomach, Damp-Heat in the middle jiao, Stomach Fire and Blood stasis affecting the Stomach collaterals [4].
Which acupuncture points are commonly considered for acute gastritis?+
Frequently considered points include CV12, ST36, PC6, SP4 and ST34. Additional points are selected according to Cold, Heat, food stagnation, Qì constraint, Dampness or Blood stasis [4].
When does suspected acute gastritis require urgent medical attention?+
Emergency assessment is required for vomiting blood, coffee-ground vomitus, black tarry stools, fainting, severe or rigid abdominal pain, persistent vomiting, severe dehydration or symptoms that could represent heart, pancreatic or biliary disease [3].
Can acupuncture or Chinese herbal medicine treat Helicobacter pylori infection?+
They must not replace validated testing and prescribed eradication therapy. Adjunctive treatment may be considered only with appropriate medical management and herb–drug interaction screening [4].
Should a patient stop NSAIDs when gastritis is suspected?+
Medication use should be reviewed promptly, but prescribed NSAIDs, aspirin or antiplatelet medicines should not be stopped without discussing the risks and alternatives with the prescribing clinician [3].
Is acute gastritis always caused by excess stomach acid?+
No. Causes include Helicobacter pylori, NSAIDs, alcohol, severe physiological stress, bile reflux, infection and other chemical or medication-related injury. Symptoms alone may not identify the cause [3].
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Sources & Further Reading
Clinical guidance, red flags and safety notes on this page draw on the following current sources alongside the classical references above.
- NICE CKS · 2024
- Therapeutic Guidelines (Australia) — Gastrointestinal · 2024
- American College of Gastroenterology · 2024
- People's Medical Publishing House · 2017
Reference for 胃痛 / 痞满 pattern differentiation.
Educational reference for licensed practitioners. Not a substitute for individual clinical assessment. Refer to conventional care for any red-flag or undiagnosed presentation.