ENGastritis treatment in Germany starts with finding the cause: gastritis is not one disease but an inflammation of the stomach lining with several possible causes, and a German gastroenterologist names the cause before treating it. Many patients arrive with chronic gastritis on file for years and one question: why do the pain and heaviness return after every course of tablets?
This page covers how the lining is examined, how Helicobacter pylori is found, how treatment differs by cause, and when surveillance is needed instead of more tablets. Symptoms, the warning signs that mean an examination should not wait, and pharmacy medicines are covered on the broader page on stomach treatment in Germany.
Why the cause comes first
The cause comes first because gastroenterology in Germany distinguishes three main forms of gastritis, each treated differently. The bacterial form is caused by Helicobacter pylori. In the autoimmune form, the immune system destroys the stomach cells that make acid and intrinsic factor, a protein needed to absorb vitamin B12. The chemical form comes from NSAID painkillers (non-steroidal anti-inflammatory drugs), acetylsalicylic acid, alcohol, or bile flowing back into the stomach in reflux.
Everything else follows from the cause. Bacteria need antibiotics. In autoimmune gastritis the stomach already makes less acid, so acid-lowering tablets fix nothing; vitamin B12 and iron, which are absorbed less well, matter more. In the chemical form the irritant has to go: the painkillers are reviewed, alcohol is stopped, reflux is treated.
Patients have usually tried a lot at home: antacids, coating agents, diets, sometimes antibiotics without a test. A generic course for the stomach may quieten the symptoms for a while, but a cause nobody has identified stays, and the symptoms return. No single regimen against gastritis exists; treatment targets a specific cause.
How a German clinic examines the stomach
A German clinic examines the stomach by gastroscopy with biopsies: the doctor looks at the lining through a thin flexible endoscope and takes samples from defined points in the antrum, near the outlet, and in the body of the stomach. The type of gastritis is read under the microscope, not from the screen, so without biopsies the diagnosis is incomplete. The examination is usually done under sedation; the procedure is described on the page on gastroscopy in Germany.
Helicobacter can be detected in several reliable ways: without an endoscope by a breath test with urea labelled with carbon-13 or a stool antigen test, and in gastroscopy samples by histology and culture. These tests are part of digestive system diagnostics. Proton pump inhibitors (PPIs, the acid-lowering tablets) are stopped two weeks before the test and antibiotics four weeks before, as both suppress the bacterium and the result may be falsely negative.
Culture or PCR of the sample also shows whether the bacterium resists clarithromycin, one of the key antibiotics, so the regimen is chosen for the actual strain rather than by guesswork. This matters most when a course at home has already failed: German recommendations then advise resistance testing, and after two failures they insist on it.
Eradication regimens
Helicobacter is treated with an acid-lowering drug plus two or three antibiotics, taken daily without gaps. For the first course, the guideline of the German medical societies prefers a four-drug regimen containing bismuth, given for at least ten days. Earlier treatment and resistance results shape the choice.
Patients are told in advance: the course must not be abandoned halfway, because missed doses markedly raise the risk of failure; nausea and loose stools are expected; alcohol is excluded throughout. The control breath or stool test comes no earlier than four weeks after the end of therapy, since feeling better does not show whether the bacterium has gone.
Without Helicobacter, autoimmune and chemical gastritis need no antibiotics. In the autoimmune form, deficiencies are corrected: replacement therapy for vitamin B12, iron where it is low. In the chemical form, painkillers are reviewed with the doctor who prescribed them, and reflux is treated in its own right. During a flare-up, gentle food is advised and the menu widened step by step, but the benefit is barely studied and diet does not remove the cause, so strict diets kept up for years make no sense. Medicines and doses are set by the gastroenterologist after gastroscopy and tests.
When gastritis needs surveillance
Surveillance is needed when long inflammation has changed the structure of the lining, as in atrophy, where glands disappear, and intestinal metaplasia, where they are replaced by intestine-like cells. German pathologists grade these changes on a common staging system, OLGA and OLGIM, and the stage decides whether and when gastroscopy with biopsies is repeated: with severe changes in both the antrum and the body, usually every two to three years.
This matters because Helicobacter pylori is classed as a group 1 carcinogen: the WHO lists it among the infections that cause cancer, and long-standing inflammation with atrophy raises the risk of stomach cancer. Eradication therefore counts as both treatment and prevention, and first-degree relatives of people with stomach cancer are advised to be tested and, if positive, treated. A raised risk is not a certainty; surveillance exists to catch changes early.
Frequently asked questions
How is gastritis treated without Helicobacter?
Gastritis without Helicobacter is treated through its cause, first clarified from the biopsies. Bile reflux is treated as such, autoimmune gastritis by replacing vitamin B12 and iron, and irritation from painkillers or alcohol by removing the irritant. Acid-lowering drugs are prescribed if symptoms persist or are severe. Gentle eating during a flare-up is sensible but does not remove the cause.
Can a blood test show that Helicobacter has gone?
No: antibodies to Helicobacter remain long after the bacterium has gone and cannot tell a current infection from a past one. Success is checked with a breath test or a stool antigen test, no earlier than four weeks after the antibiotics and two weeks after stopping PPIs. If a repeat gastroscopy is needed anyway, the biopsies are examined for the bacterium.
Can Helicobacter come back after treatment?
Reinfection in adults after successful treatment is rare in industrialised countries. If the bacterium is found soon after a course, it is most likely the original strain that survived, while the control test gave a false negative result, for instance because it was done too early or under acid-lowering tablets. Hence the strict timing of the control test, and any further regimen takes resistance into account.
How AlenMed arranges the examination and treatment
AlenMed chooses the hospital, books the examination and stays with the patient up to the final report. The network covers 86 partner hospitals in 38 German cities and 345 doctors; the company office is in Munich. Partners include the Rechts der Isar Hospital (TUM) in Munich, where Professor Roland Schmid heads the Department of Internal Medicine II, which includes gastroenterology. The programme usually takes a few days: consultation, gastroscopy with biopsies, tests, a review of the results and the prescribed regimen in hand.
The bill covers the gastroenterologist’s consultation, gastroscopy with biopsies under sedation, histology and Helicobacter tests. As a guide, a two-day gastroenterological examination programme costs €700–2,200 depending on its scope; the range is wide mainly because of whether endoscopy with biopsy is needed. The medicines of the regimen are not included, and the exact sum comes from the hospital’s estimate (Kostenvoranschlag) after the records are reviewed.
The company translates records and earlier reports, books the gastroscopy, arranges the visa invitation, meets the patient on arrival, provides a medical interpreter at the appointment, and translates the final report and regimen for the doctor at home.
This material is for information only and is not an offer. Prices are approximate; the treatment regimen is prescribed by the doctor after an in-person consultation and the biopsy result.
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