From the Guidelines
For acute gastritis not responding to supportive care, eradication therapy with a proton pump inhibitor (PPI) and two antimicrobial agents is strongly recommended, especially in cases with advanced and progressively worsening forms of gastritis, as it achieves an eradication rate of over 80% on a rigorous intention to treat basis 1.
Treatment Approach
The treatment regimen should be simple, well-tolerated, easy to comply with, and cost-effective.
- The regimen should include a PPI, such as omeprazole or esomeprazole, in combination with one, two, or three antimicrobial agents, as studied in the Maastricht Consensus Report 1.
- The goal of treatment is to achieve an eradication rate of over 80% on a rigorous intention to treat basis, which can be achieved with a combination of a bismuth preparation, an H2-receptor antagonist, or a PPI, along with antimicrobial agents 1.
Eradication Therapy
Eradication of H. pylori is associated with a decrease in the recurrence rate among patients in whom early gastric cancer is resected endoscopically, highlighting the importance of eradication therapy in cases of advanced gastritis 1.
- Eradication therapy is strongly recommended in cases with advanced and progressively worsening forms of gastritis, such as in patients with intestinal metaplasia 1.
Treatment Regimen
The treatment regimen should be tailored to the individual patient's needs, taking into account the severity of gastritis, the presence of H. pylori infection, and any other underlying medical conditions.
- A typical treatment regimen may include a PPI, such as omeprazole 20-40 mg once daily, along with two antimicrobial agents, such as amoxicillin and clarithromycin, for 10-14 days 1.
From the FDA Drug Label
Active Benign Gastric Ulcer 40 mg once daily 4 to 8 weeks The best treatment approach for acute gastritis that is not responding to supportive care is to use omeprazole 40 mg once daily for 4 to 8 weeks 2.
- The treatment duration may vary depending on the patient's response to therapy.
- It is essential to note that the efficacy of omeprazole used for longer than 8 weeks in patients with EE has not been established, but if a patient does not respond to 8 weeks of treatment, an additional 4 weeks of treatment may be given 2.
- If there is recurrence of EE or GERD symptoms, additional 4 to 8 week courses of omeprazole may be considered 2.
From the Research
Treatment Approach for Acute Gastritis
For acute gastritis that is not responding to supportive care, the following treatment approaches can be considered:
- Proton pump inhibitors (PPIs) such as omeprazole, lansoprazole, pantoprazole, or rabeprazole can be effective in reducing gastric acid secretion and promoting healing 3, 4, 5
- The dosage and duration of PPI treatment may vary depending on the severity of the condition and the presence of Helicobacter pylori infection 3, 4, 6
- Combination therapy with a PPI and two antibacterials may be necessary for patients with H. pylori-positive acute gastritis 3, 4, 6
- Pantoprazole has been shown to be effective in healing acute gastric ulcers and preventing relapse, with a similar efficacy to omeprazole 4, 5
Helicobacter pylori Eradication
For patients with H. pylori-positive acute gastritis, eradication of the infection is crucial to prevent recurrence and promote healing:
- A combination of a PPI and two antibacterials, such as metronidazole, clarithromycin, or amoxicillin, can achieve high eradication rates 3, 4, 6
- The duration of treatment may vary, but typically ranges from 6 to 14 days 4
Safety and Tolerability
PPIs, including pantoprazole and omeprazole, are generally well-tolerated and safe for use in patients with acute gastritis: