From the Guidelines
Management of gastritis identified during an EGD should prioritize treatment with proton pump inhibitors (PPIs) and, if applicable, eradication of Helicobacter pylori infection, as well as lifestyle modifications to reduce gastric irritants, as recommended by recent clinical practice updates 1. The approach to managing gastritis identified during an EGD involves several key components:
- Reducing stomach acid production with PPIs such as omeprazole 20-40 mg daily or pantoprazole 40 mg daily for 4-8 weeks to allow healing of the inflamed gastric mucosa.
- If Helicobacter pylori infection is detected, triple therapy is recommended, consisting of a PPI plus two antibiotics, usually for 10-14 days, as suggested by guidelines 1.
- Patients should avoid gastric irritants like NSAIDs, alcohol, spicy foods, and smoking to prevent further inflammation.
- Antacids can provide immediate symptom relief between PPI doses.
- For bile reflux gastritis, bile acid sequestrants may be beneficial.
- Follow-up endoscopy is typically recommended in cases of severe gastritis, dysplasia, or persistent symptoms despite treatment, with surveillance intervals determined based on histopathology results and clinical judgment, as outlined in recent best practice advice for high-quality upper endoscopy 1. This management strategy is aimed at reducing acid exposure to the inflamed gastric lining, eliminating infectious causes, and removing irritants that perpetuate inflammation, allowing the gastric mucosa to heal and preventing complications such as ulceration or bleeding.
From the FDA Drug Label
Active Benign Gastric Ulcer 40 mg once daily 4 to 8 weeks The management of gastritis identified during an Esophagogastroduodenoscopy (EGD) may involve the use of omeprazole at a dosage of 40 mg once daily for 4 to 8 weeks for the treatment of active benign gastric ulcer, which can be a cause of gastritis.
- The treatment duration may vary depending on the severity of the condition and the patient's response to therapy.
- It is essential to follow the recommended dosage regimen and administration instructions to ensure effective treatment and minimize potential side effects 2.
From the Research
Management of Gastritis in EGD
The management of gastritis identified during an Esophagogastroduodenoscopy (EGD) involves several factors, including the presence of Helicobacter pylori (H. pylori) infection and the use of non-steroidal anti-inflammatory drugs (NSAIDs).
- H. pylori Infection: Studies have shown that H. pylori is a frequent cause of histological chronic gastritis 3. The presence of H. pylori has been found to be strongly associated with gastritis, and its eradication can lead to the resolution of gastritis 4.
- NSAID Use: NSAIDs have been found to modify the inflammatory process in the gastric body, leading to a lower frequency of atrophic gastritis 3. However, the use of NSAIDs has also been found to be associated with an increased risk of peptic ulceration and gastropathy, particularly in patients with H. pylori infection 5, 6, 7.
- Treatment: The treatment of gastritis involves the eradication of H. pylori infection, if present, using a combination of antibiotics and acid suppressors 4. Additionally, the discontinuation of NSAID use or the use of alternative medications, such as proton pump inhibitors, may be necessary to manage gastritis and prevent further complications.
Factors Influencing Gastritis Management
Several factors can influence the management of gastritis, including:
- H. pylori colonization: The density of H. pylori colonization has been found to be related to the severity of gastritis, but not to the successful eradication of the infection 4.
- NSAID type: Different types of NSAIDs may have varying effects on the gastric mucosa, and some may be more likely to cause gastritis than others 6.
- Patient demographics: Patient demographics, such as age and sex, may also influence the management of gastritis, as certain populations may be more susceptible to H. pylori infection or NSAID-induced gastritis 5, 7.