What is the initial treatment for pediatric gastritis?

Initial Treatment for Pediatric Gastritis

For pediatric gastritis, proton pump inhibitors (PPIs) are the primary recommended pharmacological therapy, with dosing of 0.7-3.3 mg/kg/day for children. 1

First-Line Medication Options

Proton Pump Inhibitors (PPIs)

PPIs are the most potent acid suppressants and superior to H2 receptor antagonists (H2RAs) for treating pediatric gastritis. They effectively reduce acid production by inhibiting the H⁺-K⁺-ATPase pump in gastric parietal cells.

Recommended PPI options by age:

• Ages 1-11 years:

  • Omeprazole: 0.7-3.3 mg/kg/day 2, 1
  • Lansoprazole: 0.7-3 mg/kg/day 2
  • Esomeprazole: 0.7-3.3 mg/kg/day 1

• Ages 12-17 years:

  • Rabeprazole: 20 mg daily 2, 1
  • Adult dosing may be appropriate based on weight 1

Administration tips:

• Give PPIs approximately 30 minutes before meals for optimal effectiveness 2
• For younger children, PPI capsules can be opened and sprinkled on soft foods 2, 1

Alternative Medication Options

H2 Receptor Antagonists (H2RAs)

H2RAs may be used when PPIs are not tolerated or as an alternative therapy, though they are less effective than PPIs.

Recommended H2RA options:

• Ranitidine: 5-10 mg/kg/day divided in 2-3 doses 2, 1
• Famotidine: 1 mg/kg/day divided in 2 doses 2, 1
• Cimetidine: 30-40 mg/kg/day divided in 4 doses (for children ≥16 years) 2, 1

Important limitations:

• Tachyphylaxis develops within 6 weeks of starting treatment 2
• Cimetidine has been linked to increased risk of liver disease and gynecomastia 2

Special Considerations

H. pylori Testing and Treatment

If H. pylori infection is suspected or confirmed:

• Standard triple therapy for 14 days: PPI + amoxicillin + clarithromycin 1
• Eradication rates with this regimen are approximately 75% 3

Antacids

• Not recommended for chronic therapy in children due to safety concerns 2
• May be used for occasional symptom relief but not as primary treatment 2

Non-Pharmacological Measures

For older children and adolescents:

• Weight loss if needed
• Avoiding trigger foods
• Avoiding smoking and alcohol
• Chewing sugarless gum 2

Monitoring and Follow-up

• Assess symptom improvement after 2 weeks of therapy 1
• Consider endoscopic follow-up for complicated cases or non-responders 1
• For H. pylori infection, confirm eradication 4-8 weeks after completing therapy 1

Potential Adverse Effects

• Common PPI side effects (occurring in up to 14% of children): headaches, diarrhea, constipation, nausea 1
• Long-term acid suppression may increase risk of:
  • Community-acquired pneumonia
  • Gastroenteritis
  • Other infections 2, 1

Treatment Duration

• For uncomplicated gastritis: 4-8 weeks of therapy is typically sufficient
• For H. pylori-associated gastritis: complete the full course of eradication therapy
• Long-term PPI therapy appears to be effective and well-tolerated when necessary, with adverse events reported in only 12% of children on extended therapy 4