That burning sensation right below your ribs isn't always just the "extra spicy" wings from last night. Sometimes it lingers. It gnaws. You start wondering, how do I know if I have gastritis, or if my stomach is just having a temporary meltdown? Gastritis is one of those terms people throw around like "indigestion," but medically, it's a very specific inflammation of your stomach lining. If that lining—the mucosa—gets irritated or eroded, things get uncomfortable fast.
Most people assume it’s just acid reflux. It's not. While reflux is about acid escaping up into your esophagus, gastritis is about the stomach wall itself being under siege.
The tell-tale signs: Is it actually gastritis?
Honestly, the symptoms can be sneaky. You might feel a dull ache that gets better—or significantly worse—after you eat. It’s often described as a "gnawing" or "burning" feeling in the upper abdomen. Some people feel incredibly full after only a few bites of food, a phenomenon doctors call early satiety.
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Then there's the nausea. It’s not always the "I’m going to throw up right now" kind of nausea. It’s more of a persistent, background hum of queasiness that makes the idea of coffee or a heavy breakfast sound exhausting. If you actually do vomit, and it looks like coffee grounds, that is a massive red flag. That’s digested blood, and it means your stomach lining might be bleeding. Same goes for stool that looks black or tarry. If that's happening, stop reading this and go to a clinic.
The "Big Two" causes you should know about
You don't just wake up with an inflamed stomach for no reason. Usually, there’s a culprit.
The most common one globally is a bacteria called Helicobacter pylori (H. pylori). It’s a resilient little organism that makes itself at home in your stomach mucus. According to the Mayo Clinic, about half the world’s population has it, though most never realize it. But for some, it triggers a chronic inflammatory response that wears down the protection of the stomach.
The second major cause? NSAIDs. If you’re popping ibuprofen, naproxen, or aspirin like they’re candy for back pain or headaches, you’re basically inviting gastritis to dinner. These drugs block the enzymes that protect your stomach lining. It’s a trade-off: your headache goes away, but your stomach takes a hit.
How do I know if I have gastritis: The diagnostic path
You can't diagnose this yourself with a Google search. A doctor is going to look for specifics. They’ll likely start with a breath test or a stool sample to check for that H. pylori bacteria I mentioned. The breath test is actually pretty cool—you drink a tagged urea solution, and if the bacteria is there, it breaks it down into a specific type of carbon dioxide they can detect when you exhale.
If things seem more serious or chronic, they’ll suggest an endoscopy. I know, nobody wants a camera down their throat. But it’s the gold standard. A gastroenterologist can see the redness, the irritation, or any small sores (erosions). They might take a tiny snip of tissue—a biopsy—to look at under a microscope. This is the only way to be 100% sure if the inflammation is "acute" (sudden) or "chronic" (long-term).
Misconceptions about "Stress Gastritis"
We’ve all heard it. "You’re going to give yourself an ulcer from all that stress!" While emotional stress can make your gut feel like it’s in knots, it rarely causes true medical gastritis on its own.
Actual "stress gastritis" usually refers to physiological stress—like being in the ICU or recovering from a major burn or surgery. That kind of extreme physical trauma changes the blood flow to the stomach. Your daily work deadlines might give you a "nervous stomach" or functional dyspepsia, but unless you’re washing those deadlines down with whiskey and Advil, they probably aren't eroding your stomach lining.
Speaking of whiskey: alcohol is a direct irritant. It’s a solvent. It literally "thins" the protective barrier. If you find your stomach burns specifically after a night of drinking, that’s a loud hint from your body.
Why it matters if you ignore it
Ignoring that gnawing pain isn't "toughing it out." It’s risky. Chronic inflammation can lead to peptic ulcers—actual holes in your stomach lining. Over years, chronic gastritis (especially the type caused by H. pylori) can lead to atrophic gastritis, where the lining thins out so much that you stop absorbing Vitamin B12. This leads to pernicious anemia. Worse, long-term inflammation is a known risk factor for stomach cancer. It's rare, but it's a real consequence of letting things fester.
What you can actually do right now
If you’re sitting there thinking, "Yeah, this sounds like me," you need a plan.
First, look at your meds. If you’re taking NSAIDs daily, talk to a doctor about switching to acetaminophen (Tylenol), which doesn’t mess with the stomach lining. Second, watch the triggers. For many, it's not just "acidic" foods like lemons, but also high-fat foods that sit in the stomach longer, forcing more acid production.
Immediate Action Steps:
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- Keep a food and pain diary for 72 hours. Note exactly when the burning starts. Is it on an empty stomach? Right after coffee? This is gold for your doctor.
- Check your supplements. Some things like iron or potassium can be incredibly harsh on the stomach.
- Switch to "small and frequent." Instead of three big meals that distend the stomach, try five small ones. It keeps the acid busy without overwhelming the lining.
- Test, don't guess. If the pain lasts more than a week, get the H. pylori test. It’s non-invasive and can save you months of discomfort.
- Review your alcohol intake. Even a few days of complete abstinence can show you if alcohol is the primary driver of the irritation.
Most people find that once the underlying cause—be it a bacterial infection or a medication habit—is addressed, the stomach lining heals remarkably well. It’s a hardy organ, but it has its limits. If you've been asking how do I know if I have gastritis, the answer usually lies in the persistence of the pain and your willingness to investigate the cause rather than just masking it with over-the-counter antacids.