What is the management of mild chronic gastritis in a patient who tests negative for Helicobacter pylori (H. pylori)?

From the Guidelines

For the management of mild chronic gastritis in H. pylori negative patients, proton pump inhibitors (PPIs) are recommended as an efficacious treatment, with the lowest dose that controls symptoms being the preferred choice. This approach is based on the strongest and most recent evidence available, specifically from the British Society of Gastroenterology guidelines on the management of functional dyspepsia published in 2022 1.

Key Considerations

• The guidelines suggest that PPIs are well-tolerated and effective for symptom relief in functional dyspepsia, which can be applicable to mild chronic gastritis management in the absence of H. pylori infection.
• Histamine-2 receptor antagonists may also be considered, although the quality of evidence supporting their use is lower compared to PPIs 1.
• Lifestyle modifications, including regular aerobic exercise, are recommended, although the quality of evidence for this is very low 1.
• Dietary therapies and prokinetics may be considered, but the evidence supporting their efficacy in this context is either insufficient or varies by drug class 1.

Medication Management

• Proton pump inhibitors (such as omeprazole 20mg daily or pantoprazole 40mg daily) are the preferred choice for medication management, given their efficacy and tolerability 1.
• The duration of PPI treatment should typically be limited to 4-8 weeks to minimize the risk of potential side effects such as vitamin deficiencies and increased fracture risk.
• Antacids and H2 blockers can be used for immediate symptom relief or for moderate symptoms, respectively.

Monitoring and Follow-Up

• Patients should be monitored for warning signs that may indicate more serious conditions, such as weight loss, persistent vomiting, or blood in stool.
• If symptoms persist despite initial management, further evaluation, including repeat endoscopy, may be necessary to rule out other conditions or complications.

From the Research

Management of Mild Chronic Gastritis if H. pylori Negative

• The management of mild chronic gastritis in H. pylori negative patients can involve the use of proton pump inhibitors (PPIs) to reduce gastric acid secretion 2.
• PPIs such as lansoprazole have been shown to be effective in healing and relieving symptoms of gastric or duodenal ulcers and gastroesophageal reflux disease 2.
• Combination therapy with PPIs and histamine(2) receptor antagonists may also be used to enhance gastric acid suppression 3.
• However, the clinical significance of this finding is not clear, and further investigation is needed to determine optimal therapy in patients refractory to standard doses of PPIs 4.
• Guidelines for the diagnosis and treatment of chronic gastritis have been developed, which provide evidence-based recommendations for the management of chronic gastritis 5.
• The treatment of chronic gastritis should aim to reduce inflammation, prevent progression to more severe disease, and manage symptoms 6.
• In addition to PPIs, other treatment options may include lifestyle modifications, such as dietary changes and stress management, to help manage symptoms and reduce inflammation.
• It is essential to note that the treatment of chronic gastritis should be individualized based on the patient's specific needs and circumstances, and that regular follow-up and monitoring are necessary to ensure effective management of the disease.