What is the treatment for non-atrophic gastritis?

Treatment of Non-Atrophic Gastritis

The primary treatment for non-atrophic gastritis is Helicobacter pylori eradication therapy if H. pylori infection is present, as this is the most effective approach to reduce inflammation, prevent progression to atrophic gastritis, and reduce long-term risk of gastric cancer.

Diagnostic Approach

Before initiating treatment, proper diagnosis is essential:

1. Confirm H. pylori status:

   • Test for H. pylori using non-serological methods (urea breath test, stool antigen test)
   • All individuals with gastritis should be assessed for H. pylori infection 1

2. Endoscopic evaluation with biopsies:

   • Obtain biopsies from both the gastric body and antrum/incisura in separate containers
   • Histopathological confirmation is necessary to differentiate non-atrophic from atrophic gastritis 1

Treatment Algorithm for Non-Atrophic Gastritis

For H. pylori-Positive Non-Atrophic Gastritis:

1. First-line treatment:

   • Administer appropriate H. pylori eradication therapy based on local resistance patterns
   • Confirm successful eradication using non-serological testing modalities 1

2. Important caution:

   • Monotherapy with H2-receptor blockers without antibacterial agents increases the degree of gastric mucosa colonization with H. pylori and should be avoided 2
   • If acid suppression is needed, it should be combined with appropriate antibacterial therapy

3. Post-eradication follow-up:

   • Confirm eradication success 4-8 weeks after therapy completion
   • Symptoms typically improve within 4 weeks after successful eradication 1

For H. pylori-Negative Non-Atrophic Gastritis:

1. Identify and address potential causes:

   • Discontinue NSAIDs or other potentially irritating medications
   • Consider other etiologies (alcohol, bile reflux, stress)

2. Symptomatic treatment:

   • Short-term acid suppression with ranitidine (H2-blocker) for symptomatic relief
     • Typical dosage: 150 mg twice daily for GERD symptoms 3
   • Antacids as needed for pain relief 3

Monitoring and Follow-up

1. For non-atrophic gastritis without intestinal metaplasia:

   • No specific surveillance is required if symptoms resolve
   • Consider repeat endoscopy if symptoms persist despite treatment

2. Risk assessment:

   • Non-atrophic gastritis can progress to atrophic gastritis, which increases gastric cancer risk
   • H. pylori eradication can prevent progression to atrophic gastritis 4

Special Considerations

1. Autoimmune features:

   • If autoimmune features are present, consider checking antiparietal cell antibodies and anti-intrinsic factor antibodies 1
   • Early H. pylori eradication may prevent progression to autoimmune atrophic gastritis 5

2. Nutritional assessment:

   • Even in non-atrophic gastritis, evaluate for iron deficiency, especially if corpus-predominant inflammation 1

3. Medication considerations:

   • Avoid long-term PPI use without clear indication as it may accelerate progression to atrophic changes
   • If NSAIDs are required, H. pylori eradication is recommended before initiating long-term NSAID therapy 6

Clinical Pitfalls to Avoid

1. Missing H. pylori infection:

   • Use multiple testing methods if clinical suspicion is high but initial test is negative
   • Recent PPI use can cause false-negative results

2. Inadequate biopsy sampling:

   • Ensure proper topographic sampling (both antrum and corpus)
   • Insufficient biopsies may miss focal disease

3. Failure to confirm eradication:

   • Always confirm successful H. pylori eradication after treatment
   • Treatment failure increases risk of progression to atrophic gastritis

4. Overuse of acid suppressants:

   • Prolonged acid suppression without H. pylori eradication may worsen infection and inflammation 2
   • PPIs are not indicated in patients who develop hypochlorhydria 7

By following this treatment approach, most patients with non-atrophic gastritis will experience symptom resolution and prevention of progression to more advanced gastric lesions.