CHRONIC GASTRITIS: CLINICAL COURSE, DIAGNOSIS AND MODERN TREATMENT APPROACHES TO HELICOBACTER PYLORI INFECTION

Abstract

Chronic gastritis is one of the clinically significant gastrointestinal disorders characterized by persistent inflammation of the gastric mucosa, impaired regenerative processes, and, depending on the underlying etiology, progressive structural and functional alterations, including glandular atrophy and metaplastic changes. Helicobacter pylori (H. pylori) infection represents one of the major etiological factors associated with chronic gastritis. Persistent colonization of the gastric mucosa by this microorganism may induce chronic inflammatory responses and contribute to the development of glandular atrophy, intestinal metaplasia, peptic ulcer disease, and, in susceptible individuals, gastric neoplasia. Consequently, contemporary gastroenterology increasingly considers H. pylori gastritis not merely as a symptomatic gastrointestinal disorder but as an infectious disease with important long-term clinical and morphological consequences.                                                                                   This article analyzes the etiology and pathogenesis of chronic gastritis, its principal clinical manifestations, current approaches to the diagnosis of H. pylori infection, and modern principles of eradication therapy. Patients with chronic gastritis may present with epigastric pain or discomfort, postprandial fullness, early satiety, belching, nausea, abdominal bloating, and other dyspeptic manifestations. However, these symptoms are nonspecific and cannot independently establish a diagnosis of gastritis. Therefore, clinical assessment should be integrated with endoscopic, histological, and microbiological findings when clinically indicated. Non-invasive diagnostic methods, particularly the urea breath test and stool antigen test, play an important role in detecting active H. pylori infection. Upper gastrointestinal endoscopy with biopsy and subsequent histological or rapid urease assessment remains particularly relevant for patients with alarm features or an increased risk of organic gastrointestinal disease. The article also emphasizes the growing problem of antimicrobial resistance and the need to consider previous antibiotic exposure, regional resistance patterns, and, where available, antimicrobial susceptibility testing when selecting eradication therapy. According to the 2024 American College of Gastroenterology recommendations, optimized bismuth quadruple therapy represents an important empiric first-line treatment option in appropriate patients. Alternative regimens may be considered depending on previous treatment exposure, susceptibility data, availability, and individual clinical circumstances. Confirmation of eradication after completion of treatment is an essential component of contemporary H. pylori management because clinical improvement alone does not reliably demonstrate bacterial clearance. A comprehensive approach combining etiological diagnosis, appropriate eradication therapy, adherence assessment, post-treatment verification, and risk-based follow-up is therefore essential for improving long-term clinical outcomes.