What is the initial treatment for mild chronic gastritis?

From the Guidelines

The initial treatment for mild chronic gastritis should focus on lifestyle modifications and medication to reduce stomach acid, with a strong emphasis on testing for and eradicating H. pylori infection if present, as this bacterium is a major cause of gastritis and is associated with an increased risk of gastric cancer 1.

Key Recommendations

• Patients should avoid triggers like alcohol, spicy foods, NSAIDs, and smoking to reduce stomach acid production and prevent further irritation of the stomach lining.
• Dietary changes include eating smaller, more frequent meals and limiting acidic or fatty foods to reduce symptoms and allow the stomach lining to heal.
• Over-the-counter antacids (such as Tums or Maalox) can provide quick symptom relief by neutralizing stomach acid.
• For persistent symptoms, H2 blockers like famotidine (Pepcid) 20mg twice daily or proton pump inhibitors such as omeprazole (Prilosec) 20mg once daily before breakfast are recommended for 4-8 weeks to reduce acid production and allow the stomach lining to heal.
• If H. pylori infection is confirmed, triple therapy is necessary, typically consisting of a PPI plus two antibiotics (amoxicillin 1g and clarithromycin 500mg, all twice daily for 14 days) to eradicate the infection and prevent long-term complications such as gastric cancer 1.

Rationale

The treatment of mild chronic gastritis should prioritize the reduction of stomach acid production and the eradication of H. pylori infection if present, as this bacterium is a major cause of gastritis and is associated with an increased risk of gastric cancer 1. The use of lifestyle modifications, antacids, H2 blockers, and proton pump inhibitors can help to reduce symptoms and allow the stomach lining to heal, while triple therapy can effectively eradicate H. pylori infection and prevent long-term complications.

Considerations

• The increasing resistance to antibiotics, particularly clarithromycin, may affect the efficacy of triple therapy, and alternative treatment regimens may be necessary in some cases 1.
• The importance of testing for and eradicating H. pylori infection cannot be overstated, as this bacterium is a major cause of gastritis and is associated with an increased risk of gastric cancer 1.
• Stress management techniques may also help to reduce symptoms and improve quality of life for patients with mild chronic gastritis.

From the Research

Initial Treatment for Mild Chronic Gastritis

The initial treatment for mild chronic gastritis often involves the use of proton pump inhibitors (PPIs) to reduce stomach acid production.

• PPIs, such as omeprazole and lansoprazole, have been shown to be safe and effective for long-term use in patients with peptic ulcer disorders 2.
• In cases where Helicobacter pylori infection is present, a combination of PPIs and antibiotics, such as macrolides, may be used to treat the infection 3, 4.
• However, chronic use of PPIs may mask H. pylori infections, leading to a diagnosis of non-H. pylori gastritis and increasing the risk of intestinal metaplasia 5.
• The effectiveness of PPIs in treating H. pylori infection may also depend on the patient's CYP2C19 genotype status, with poor metabolizers having higher eradication rates than extensive metabolizers 6.

Treatment Options

• PPIs, such as omeprazole and lansoprazole, are commonly used to treat mild chronic gastritis.
• Antibiotics, such as macrolides, may be used in combination with PPIs to treat H. pylori infections.
• High-dose PPIs and antibiotics, such as amoxicillin, may be used as a re-treatment option for patients who do not respond to initial treatment 6.

Considerations

• The use of PPIs should be judicious and only used when clearly indicated, as long-term therapy may be associated with rebound symptoms and other adverse effects 2.
• Patients with H. pylori infection should be treated with a combination of PPIs and antibiotics to reduce the risk of gastric mucosal atrophy and other long-term complications 4, 5.