Gastritis 101: My Testing Flow Chart
I’ve been dealing with gastritis for over 2 years now. That might be a scary thing to hear but fear not, I’m feeling okay most days and good on many others. The reason my gastritis has taken so long to heal is because it’s been a challenge for me to get proper testing. In lieu of tests, doctors have doled out Proton Pump Inhibitors (PPIs) like they’re candy and diagnosed me (and rediagnosed me) with a variety of conditions. They’ve let me down, to say the least.
After a year of seriously struggling (weight loss, anxiety, no improvement in symptoms with PPIs), they finally ordered an endoscopy for me (but I did kind of have to beg). The endoscopy revealed bile in my stomach, which could suggest I have bile reflux (something that is worrisomely underdiagnosed and does not respond to PPIs at all), which could be prolonging my healing.
I am just now (2 years later) getting a SIBO test, which I tried to order through a doctor, but 3 of them refused to do so, so I ended up paying out of pocket to a private company to get an at-home test.
If I do end up testing positive for SIBO, this is another factor that could be prolonging my healing and, with the proper treatment, I could eliminate my gastritis altogether (lord willing).
All of this to say — testing can be so important, but it is hard to come by. In this post, I will cover all the possible avenues of testing that can be relevant for treating long-term/chronic gastritis in cases not caused by H. Pylori or autoimmune disease. Although it may be difficult to convince doctors that you do truly need testing, I will at least provide you with a testing overview so that you can go equipped with knowledge the next time you visit your GP or GI.
The Testing Flow Chart
If you have symptoms of nausea, early satiety, heartburn, burning/gnawing in stomach, and other upper-gastrointestinal discomfort that occurs regularly for longer than 2 weeks, it’s time to explore testing.
1. The H. Pylori Test
If you test positive for H. Pylori, getting on a treatment plan is crucial to help your healing. Antibiotics are the usual way to go, but they can often worsen gut issues, so be sure to take them on an empty stomach and along with a high-quality probiotic and stomach-protection like DGL and Zinc Carnosine. There are some natural remedies that have been shown to reduce H. Pylori but antibiotics in combination with such remedies are key to full eradication, in my opinion.
Please note: You must be off Proton-Pump Inhibitors for at least 2 weeks to ensure an accurate test.
If you test negative for H. Pylori, that’s good news. But this is the time when we can delve into some other possible root causes.
2. The Endoscopy
If you have months without symptom relief, and a gastritis-friendly diet is helping but perhaps not enough, this may be a good time to request an endoscopy. An endoscopy is an invasive procedure that takes images of the inside of your stomach and esophagus and monitors the level and location of any inflammation. Doctors are often hesitant to order this test; however, if you have been suffering for months, I highly recommend pushing for this test to get a better idea of what’s actually going on.
An endoscopy can show you:
The severity of inflammation
The location of inflammation,
And any bile present in the stomach.
Each of these are important markers to put you on your unique healing path.
3. Acid Tests
Common acid tests include:
24-hour pH monitoring
Bravo pH capsule
Symptom response to PPIs (informal “test”)
They tell you:
If acid exposure is excessive
If symptoms correlate with acid reflux
If PPIs should help
They work best when:
Heartburn is dominant
Burning improves clearly with PPIs
There’s classic GERD
Most GI treatment plans assume acid is the problem, but gastritis can be caused by acid, bile, both, or neither (immune, NSAID, ischemic, stress-related).
If you have bile reflux or a combination of acid/bile reflux, PPIs can actually worsen symptoms.
4. Bile Tests
Bile reflux can be identified via:
Endoscopy
Impedence-pH Testing
Symptoms such as
Burning without classic heartburn
Bitter or metallic taste
Symptoms worse when lying down
Poor response or worsening on PPIs
Nausea > pain
Nighttime symptoms
Bile reflux is often overlooked in the medical world, but identifying this is key to navigating healing.
5. Basic Blood Work
These don’t often diagnose gastritis but show markers of inflammation.
CBC (anemia?)
Ferritin / iron
B12
Folate
Vitamin D
CMP (liver + gallbladder clues)
Thyroid panel (sluggish motility = reflux risk)
Low stomach acid, bile issues, or chronic inflammation often show up here.
6. Functional Testing
Once stomach inflammation is addressed, you can start to look at the gut environment and issues that might be prolonging healing.
SIBO Testing - Consider if you have:
Bloating
Trapped gas
Distension
Constipation or diarrhea
Symptoms several hours after meals
Stool Testing - GI Map / equivalent. Can assess:
Dysbiosis
Opportunistic bacteria
Parasites
Yeast overgrowth
Inflammation markers
Pancreatic enzymes
Motility & nervous system
History of stress, anxiety, trauma
Vagus nerve tone
Sleep timing
Eating schedule
Autoimmune screening (select cases)
Only if suggested by biopsy or labs:
Autoimmune gastritis
Pernicious anemia markers
Parietal cell antibodies
This is not a checklist. This is an (almost) comprehensive list of tests that can help you identify the root cause of your gut health issues. There is often more than one root cause, and stress is almost always at least one piece of the puzzle when it comes to healing gastritis.
Start with the endoscopy + H. Pylori biopsy first, treat and protect if necessary, and only move on to other testing if symptoms don’t resolve after treatment of H. Pylori and/or after 3 months of a healing diet/supplement regimen.
As always, if you’re looking for extra guidance, feel free to reach out to me.
You will find your answers. Healing is possible.