What is the treatment for acute gastritis?

Treatment of Acute Gastritis

The cornerstone of acute gastritis treatment is proton pump inhibitor (PPI) therapy, with omeprazole 20-40mg once daily for 4-8 weeks being the first-line treatment, combined with appropriate rehydration therapy and testing for Helicobacter pylori in cases of suspected infection. 1, 2

Initial Management

Rehydration Therapy

• For mild to moderate dehydration: Oral rehydration solution (ORS) containing 45-75 mEq/L sodium
• For severe dehydration: Intravenous isotonic fluids (preferably Ringer's lactate or normal saline)
• Continue rehydration until pulse, perfusion, and mental status normalize 2

Acid Suppression Therapy

• First-line treatment: Proton pump inhibitors (PPIs)
  • Omeprazole 20mg once daily for 4-8 weeks for most cases 1
  • Increase to 40mg once daily for severe cases or benign gastric ulcers 1
• Alternative: H2-receptor antagonists
  • Ranitidine 150mg twice daily (if PPIs are contraindicated) 3

Etiology-Specific Treatment

H. pylori-Associated Gastritis

• Test for H. pylori in patients with:

  • Persistent symptoms
  • History of peptic ulcer disease
  • Risk factors for gastric cancer
  • Use of NSAIDs or aspirin 4

• If H. pylori positive, eradication therapy:

  • Triple therapy: Omeprazole 20mg + Amoxicillin 1000mg + Clarithromycin 500mg, all twice daily for 10-14 days 1, 5
  • Early eradication therapy has shown to be efficacious in achieving faster healing in acute H. pylori gastritis 5

NSAID-Induced Gastritis

• Discontinue NSAIDs if possible
• PPI therapy (omeprazole 20-40mg daily) for 4-8 weeks 1, 6
• For patients requiring continued NSAID therapy:
  • H. pylori eradication is beneficial before starting NSAID treatment 4
  • H. pylori eradication is mandatory in patients with a peptic ulcer history 4

Stress-Related Gastritis

• PPI therapy (omeprazole 20-40mg daily) 1
• Address underlying condition causing physiological stress
• Ensure adequate tissue perfusion and oxygenation

Dietary and Supportive Management

• Resume age-appropriate diet during or immediately after rehydration 2
• Follow a bland diet (BRAT: Bananas, Rice, Applesauce, Toast) initially 2
• Avoid:
  • Spicy foods
  • Coffee and alcohol
  • Foods high in simple sugars and fats 2
• Continue breastfeeding in infants throughout the illness 2

Monitoring and Follow-up

• Reassess hydration status regularly until corrected 2
• Evaluate patients after 48-72 hours of treatment 2
• Consider alternative diagnoses if no improvement occurs 2
• For severe or complicated cases, follow-up endoscopy may be necessary to confirm healing

Special Considerations

Phlegmonous Gastritis

• Rare but severe bacterial infection of the gastric wall
• Requires aggressive antibiotic therapy based on culture results
• Medical treatment with appropriate antibiotics can be successful without requiring gastrectomy 7

Severe Acute H. pylori Gastritis

• May present with endoscopic findings resembling lymphoma or carcinoma
• Requires prompt antibiotic treatment and PPI therapy 8, 9
• Histological examination is essential for accurate diagnosis 9

Pitfalls and Caveats

• Long-term PPI use in H. pylori-positive patients may accelerate development of atrophic gastritis 4
• H. pylori eradication prevents progression to atrophic gastritis in patients requiring long-term PPI therapy 4
• PPIs may mask symptoms without addressing underlying cause
• Consider drug interactions when prescribing PPIs (take before meals, may affect absorption of other medications) 1
• Avoid antimotility agents in inflammatory diarrhea as they can worsen outcomes 2

Remember that early diagnosis and appropriate treatment are crucial for preventing complications and improving outcomes in patients with acute gastritis.