What is the treatment for chronic gastritis?

Treatment of Chronic Gastritis

The treatment of chronic gastritis should primarily focus on eradication of Helicobacter pylori infection, which is the most common cause of chronic gastritis and a significant risk factor for gastric cancer development. 1

Diagnostic Approach

Before initiating treatment, proper diagnosis is essential:

1. Histological confirmation: Chronic gastritis should be confirmed by histopathology, regardless of etiology 1

2. H. pylori testing: All individuals with chronic gastritis must be assessed for H. pylori infection 1

3. Endoscopic evaluation: When endoscopic features of gastritis are present, biopsies should be obtained from:

   • Body and antrum/incisura (minimum requirement)
   • Any other mucosal abnormalities 1

4. For suspected autoimmune gastritis: Check antiparietal cell antibodies, anti-intrinsic factor antibodies, and evaluate for vitamin B12 and iron deficiencies 1

Treatment Algorithm

1. H. pylori-Associated Chronic Gastritis

• First-line therapy: Triple therapy consisting of:

  • Proton pump inhibitor (e.g., lansoprazole)
  • Clarithromycin
  • Amoxicillin 2, 3

• Alternative therapy (for clarithromycin-allergic patients or suspected resistance):

  • Dual therapy with amoxicillin and lansoprazole 2

• Post-treatment confirmation: Successful eradication should be confirmed using non-serological testing modalities 1

2. Autoimmune Gastritis

• Vitamin replacement:

  • Vitamin B12 supplementation for deficiency
  • Iron supplementation for iron deficiency 1

• Monitoring: Surveillance endoscopy should be considered based on individual risk assessment 1

• Screening: Evaluate for concomitant autoimmune disorders, particularly autoimmune thyroid disease 1

3. Other Forms of Chronic Gastritis

• Symptomatic treatment:
  • Proton pump inhibitors for acid-related symptoms
  • Antacids for mild symptoms

Follow-up and Surveillance

• Post-H. pylori eradication: Follow-up testing to confirm eradication is essential 1

• Surveillance endoscopy: Consider surveillance every 3 years for patients with advanced atrophic gastritis 1

• Nutritional monitoring: Evaluate for iron and vitamin B12 deficiencies in all patients with atrophic gastritis, especially if corpus-predominant 1

Clinical Importance of Treatment

Early treatment of chronic gastritis, particularly H. pylori eradication, is crucial because:

1. Cancer prevention: H. pylori eradication reduces the risk of gastric cancer development 1

2. Greater efficacy with early intervention: Risk of gastric cancer can be reduced more effectively by employing eradication treatment before the development of preneoplastic conditions 1

3. Halting progression: H. pylori eradication abolishes inflammatory response and may slow or arrest the progression of atrophy 1

Common Pitfalls to Avoid

1. Failing to confirm eradication: Always confirm successful H. pylori eradication using non-serological testing

2. Overlooking nutritional deficiencies: Patients with atrophic gastritis often develop vitamin B12 and iron deficiencies that require supplementation

3. Ignoring high-risk populations: Certain populations have higher risk for H. pylori infection and gastric cancer and may need more aggressive screening and treatment approaches 1

4. Inadequate biopsy sampling: Proper diagnosis requires adequate biopsies from both the antrum and body of the stomach

5. Missing autoimmune etiology: Consider autoimmune gastritis in patients with unexplained vitamin B12 or iron deficiency

The evidence strongly supports that early diagnosis and treatment of chronic gastritis, particularly through H. pylori eradication, is the most effective strategy to prevent progression to more serious conditions including gastric cancer 1.