From the Guidelines
Proton pump inhibitors (PPIs) should be used for gastritis only when medically necessary and typically for a limited duration, as recommended by the most recent guidelines 1.
Gastritis Treatment
For acute gastritis, PPIs like omeprazole (20-40mg daily), pantoprazole (40mg daily), or esomeprazole (20-40mg daily) may be prescribed for 4-8 weeks to reduce stomach acid production and allow healing of the inflamed stomach lining. The standard dose of PPIs is as follows: pantoprazole 40mg, lansoprazole 30mg, omeprazole 20mg, esomeprazole 20mg, dexlansoprazole 30mg, rabeprazole 20mg, as stated in the study 1.
Potential Side Effects
Regular, long-term PPI use without medical supervision is not recommended due to potential side effects including increased risk of bone fractures, vitamin B12 deficiency, kidney problems, and increased susceptibility to certain infections.
Lifestyle Modifications
For mild gastritis, lifestyle modifications should be tried first, including:
- Avoiding trigger foods (spicy, acidic, fatty)
- Limiting alcohol
- Quitting smoking
- Managing stress
- Eating smaller, more frequent meals If symptoms persist beyond 2 weeks or worsen despite these measures, medical evaluation is necessary to determine the underlying cause of gastritis and appropriate treatment.
De-Prescribing PPIs
According to the study 1, all patients taking a PPI should have a regular review of the ongoing indications for use and documentation of that indication, and the primary care provider (PCP) should be primarily responsible for reviewing the presence of ongoing indications for PPI use, and identifying candidates for de-prescribing. PPIs work by blocking the enzyme system responsible for acid secretion in the stomach, which reduces irritation to the inflamed stomach lining and promotes healing, as mentioned in the study 1.
From the FDA Drug Label
Patients should use the lowest dose and shortest duration of PPI therapy appropriate to the condition being treated.
The use of PPIs, such as omeprazole and lansoprazole, for gastritis should be done with caution and under the guidance of a healthcare professional. Key considerations include:
- Using the lowest effective dose for the shortest duration necessary to treat the condition
- Being aware of the potential risks and side effects associated with long-term PPI use, such as increased risk of gastrointestinal infections, osteoporosis-related fractures, and hypomagnesemia
- Monitoring for signs and symptoms of adverse effects, such as diarrhea, malaise, and nausea
- Considering alternative treatments for gastritis, if possible, to minimize the risk of long-term PPI use 2, 3
From the Research
Use of Proton Pump Inhibitors (PPIs) for Gastritis
- PPIs are widely used in the treatment of acid-peptic diseases, including gastritis, and are effective in alleviating acid-peptic symptoms and facilitating healing of inflamed or ulcerated mucosa 4.
- The use of PPIs is increasingly long-term, frequently for a lifetime, in patients with typical or atypical symptoms of gastro-oesophageal reflux disease, and in NSAID or aspirin users at risk for gastrotoxicity and related complications 4.
- Long-term PPI use accounts for the majority of total PPI use, with absolute indications including peptic ulcer disease, chronic nonsteroidal anti-inflammatory drugs use, treatment of Helicobacter pylori, and erosive esophagitis 5.
Safety and Adverse Effects of PPIs
- Although PPIs are generally considered safe, numerous adverse effects, particularly associated with long-term use, have been reported 5.
- Many patients receiving chronic PPI therapy do not have clear indications for their use, prompting consideration for reduction or discontinuation of their use 5.
- Common adverse effects of PPIs include diarrhea, headache, dizziness, flatulence, abdominal pain, and constipation 6.
Treatment of Helicobacter pylori Infection
- Treatment of Helicobacter pylori infection with a combination of PPIs and antibiotics is effective in improving healing and preventing complications and recurrences of gastric or duodenal ulcer 7.
- The choice of antibiotics is based on trials in which the primary endpoint was a negative urea breath test, which is an acceptable surrogate criterion 7.
- PPIs possess antibacterial activity against H. pylori in vitro, and may also exert an anti-inflammatory effect by interfering with the cellular immune response to infection 8.
Use of PPIs for Gastritis
- PPIs may be used regularly for gastritis, particularly in patients with Helicobacter pylori infection or those at risk for gastrotoxicity and related complications 4, 5, 7.
- However, the use of PPIs should be carefully considered, taking into account the potential risks and benefits, and alternative treatments should be explored in patients without clear indications for PPI use 5.