What is the treatment for acute gastritis in children?

Treatment of Acute Gastritis in Children

The first-line treatment for acute gastritis in children is proton pump inhibitors (PPIs) such as omeprazole 20-40mg once daily for 4-8 weeks, combined with appropriate rehydration therapy and testing for H. pylori in cases of suspected infection. 1

Assessment and Diagnosis

• Evaluate hydration status using physical examination findings
• Consider the Clinical Dehydration Scale to determine severity 2
• Test for H. pylori in children with:
  • Persistent symptoms
  • History of peptic ulcer disease
  • Risk factors for gastric cancer
  • Use of NSAIDs or aspirin 1

Treatment Algorithm

1. Rehydration Therapy (Primary Intervention)

• Mild dehydration: Oral rehydration therapy (ORT)

  • Reduced osmolarity oral rehydration solution (ORS)
  • Half-strength apple juice followed by preferred liquids is effective 1, 2

• Moderate dehydration: Oral rehydration solutions

  • ORS containing 65-70 mEq/L sodium and 75-90 mmol/L glucose
  • Nasogastric administration if unable to tolerate oral intake 1

• Severe dehydration: Intravenous fluids

  • Ringer's lactate is preferred as it better corrects metabolic acidosis 1
  • Hospitalization is recommended 2

2. Pharmacological Management

• Proton Pump Inhibitors:

  • Omeprazole 20-40mg once daily for 4-8 weeks 1
  • Safety established in children 2-16 years for GERD and erosive esophagitis 3
  • Caution: Not established in children <1 year for most indications 3

• H2-Receptor Antagonists (alternative):

  • Ranitidine can be used when PPIs are contraindicated 4
  • Safety established in children 1 month to 16 years 4

• Anti-emetics (if vomiting impairs ORT):

  • Ondansetron may be prescribed to prevent vomiting and improve tolerance of oral rehydration solutions 1, 2, 5
  • Helps facilitate ORT and may reduce need for IV therapy 5

3. H. pylori Eradication (if positive)

• Triple therapy with omeprazole, amoxicillin, and clarithromycin 1
• Treatment should be started as soon as possible after diagnosis 6

Dietary Management

• Continue age-appropriate diet during or immediately after rehydration 1
• For breastfed infants: Continue breastfeeding throughout rehydration 1
• Consider bland/BRAT diet (Bananas, Rice, Applesauce, Toast) 1
• Avoid spicy foods, coffee, and foods high in simple sugars and fats 1
• Zinc supplementation beneficial for children 6 months to 5 years with malnutrition 1
• Probiotics may reduce symptom severity and duration 1

Important Considerations and Caveats

• NSAID discontinuation: If NSAIDs are contributing to gastritis, discontinue use 1
• Antimicrobial therapy: Not recommended for most cases of acute watery diarrhea unless specific indications exist 1
• Monitoring:
  • Reassess hydration status regularly until corrected
  • Evaluate after 48-72 hours of treatment
  • Consider alternative diagnoses if no improvement occurs 1
• PPI safety in children: Monitor for potential side effects; animal studies show potential effects on bone development with long-term use at high doses 3

Prevention

• Implement proper hand hygiene practices
• Educate patients and caregivers about food and water safety
• Rotavirus vaccination reduces incidence of acute gastroenteritis in young children 2

Remember that acute gastritis in children is often self-limiting, but proper rehydration and symptomatic treatment are essential to prevent complications and improve outcomes.