From the Guidelines
The recommended treatment for severe gastritis involves a multi-faceted approach, including proton pump inhibitors (PPIs) and triple therapy with a PPI plus two antibiotics, such as amoxicillin and clarithromycin, for 14 days, as supported by the most recent and highest quality study 1.
Treatment Approach
The treatment of severe gastritis typically involves:
- Proton pump inhibitors (PPIs) such as omeprazole (20-40mg daily), pantoprazole (40mg daily), or esomeprazole (20-40mg daily) for 4-8 weeks to reduce stomach acid production and allow the stomach lining to heal.
- Triple therapy with a PPI plus two antibiotics, such as amoxicillin 1g twice daily and clarithromycin 500mg twice daily, for 14 days, as recommended by the most recent study 1.
- Antacids containing aluminum hydroxide and magnesium hydroxide can provide immediate symptom relief.
- Patients should avoid gastric irritants such as alcohol, NSAIDs, spicy foods, and caffeine during the healing process.
- Dietary modifications include eating smaller, more frequent meals and staying hydrated.
Rationale
The rationale for this approach is based on the understanding that Helicobacter pylori infection is a major cause of gastritis, and that eradication of the infection is essential for cure 1. The use of triple therapy with a PPI and two antibiotics has been shown to be effective in eradicating the infection and reducing the risk of complications such as peptic ulcers and gastric cancer 1.
Considerations
In severe cases with bleeding, hospitalization may be necessary for intravenous PPIs, fluid replacement, and possibly endoscopic intervention. The management of H. pylori infection is in the midst of a major transformation, with a focus on achieving high cure rates and adopting the principles of antibiotic usage and antimicrobial stewardship 1.
From the FDA Drug Label
INDICATIONS AND USAGE Ranitidine tablets USP are indicated in: ... 4. Short-term treatment of active, benign gastric ulcer. Concomitant antacids should be given as needed for pain relief to patients with active duodenal ulcer; active, benign gastric ulcer;
The recommended treatment for severe gastritis is not explicitly stated, but ranitidine can be used for the short-term treatment of active, benign gastric ulcer. It is also recommended to give concomitant antacids as needed for pain relief. 2
From the Research
Treatment Options for Severe Gastritis
The treatment of severe gastritis often involves a combination of medications and lifestyle changes. Some of the treatment options include:
- Proton pump inhibitors (PPIs) such as omeprazole, lansoprazole, and pantoprazole to reduce stomach acid production 3, 4
- Antibiotics to treat Helicobacter pylori (H. pylori) infections, which are a common cause of gastritis 5, 6
- Antacids and histamine-2 (H2) blockers to help neutralize stomach acid and relieve symptoms
Medication Regimens
Studies have shown that a combination of omeprazole, amoxicillin, and clarithromycin is effective in eradicating H. pylori infections and treating gastritis 5. Esomeprazole, a newer PPI, has also been shown to be effective in treating gastric acid-related diseases, including gastritis 6.
Lifestyle Changes
In addition to medication, lifestyle changes such as:
- Quitting smoking, which can help reduce the risk of treatment failure 5
- Avoiding alcohol and nonsteroidal anti-inflammatory drugs (NSAIDs), which can irritate the stomach lining
- Eating a healthy diet and avoiding spicy or fatty foods, which can help reduce symptoms
Treatment Strategies
Different treatment strategies, such as step-up and step-down therapy, may be used to manage gastritis and gastroesophageal reflux disease (GERD) 7. The choice of treatment strategy will depend on the individual patient's needs and the severity of their symptoms.