What is the treatment for acute gastritis?

Treatment of Acute Gastritis

The primary treatment for acute gastritis includes proton pump inhibitors (PPIs) such as omeprazole 20-40 mg once or twice daily for 4-8 weeks, along with elimination of potential causative factors and supportive care. 1

Diagnosis and Assessment

• Acute gastritis is characterized by inflammation of the gastric mucosa that can present with:

  • Epigastric pain or discomfort
  • Nausea and vomiting
  • Loss of appetite
  • Occasionally, upper gastrointestinal bleeding

• Key factors to identify in history:

  • Recent NSAID use
  • Alcohol consumption
  • Helicobacter pylori infection status
  • Recent physiologic stress (trauma, burns, critical illness)

Treatment Algorithm

Step 1: Eliminate Causative Factors

• Discontinue NSAIDs if possible
• Avoid alcohol consumption
• Eliminate other gastric irritants (spicy foods, caffeine)

Step 2: Pharmacologic Therapy

1. First-line: Proton Pump Inhibitors

   • Omeprazole 20-40 mg once or twice daily for 4-8 weeks 1
   • Higher potency PPIs like esomeprazole or rabeprazole (20-40 mg twice daily) are preferred over pantoprazole 2

2. Alternative options:

   • H2 receptor antagonists (if PPIs contraindicated)
   • Antacids for immediate symptom relief

Step 3: H. pylori Testing and Treatment

• Test for H. pylori if suspected or in cases of recurrent symptoms
• If H. pylori positive, treat with appropriate eradication therapy:
  • Triple therapy: Omeprazole 20 mg + Amoxicillin 1000 mg + Clarithromycin 500 mg, all twice daily for 10 days 1
  • Continue omeprazole 20 mg daily for additional 18 days if ulcer is present 1

Step 4: Supportive Care

• Maintain adequate hydration
• Small, frequent meals
• Avoid fasting for prolonged periods

Special Considerations

Acute Hemorrhagic Gastritis

For patients with acute hemorrhagic gastritis (presenting with upper GI bleeding):

• Fluid resuscitation as needed
• Higher dose PPI therapy (omeprazole 40 mg twice daily)
• Consider endoscopic evaluation and intervention if bleeding is severe 3
• Goal-directed fluid therapy for patients with significant bleeding 2

H. pylori Considerations

• H. pylori eradication is essential if infection is present, as it significantly reduces recurrence risk 2
• PPIs alone have limited effect on H. pylori eradication (0-15% eradication rates) 4
• Triple therapy with PPI + two antibiotics is most effective for H. pylori eradication (>80% success) 4

Monitoring and Follow-up

• Reassess symptoms after 2-4 weeks of therapy
• Consider endoscopic evaluation if:
  • Symptoms persist despite 4-8 weeks of therapy
  • Patient is >45 years old with new-onset symptoms
  • Alarm symptoms present (weight loss, anemia, dysphagia)

Pitfalls and Caveats

• PPIs alone have minimal effect on H. pylori eradication and should not be used as monotherapy for H. pylori-associated gastritis 4
• Long-term PPI use in H. pylori-positive patients can accelerate progression to atrophic gastritis 2
• Pantoprazole should be avoided when possible due to lower relative potency compared to other PPIs 2
• Hydroxyethyl starch fluids should be avoided in patients with severe hemorrhagic gastritis requiring fluid resuscitation 2

By following this algorithm, most cases of acute gastritis will resolve with appropriate treatment targeting the underlying cause while providing symptomatic relief through acid suppression.