What is the treatment for alcoholic gastritis?

Treatment of Alcoholic Gastritis

The primary treatment for alcoholic gastritis is complete alcohol abstinence, which must be combined with proton pump inhibitors, nutritional support, and management of associated symptoms. 1, 2

First-Line Interventions

• Alcohol abstinence is the most important and fundamental treatment for alcoholic gastritis, as continued alcohol consumption perpetuates mucosal damage and inflammation 1, 2

• Proton pump inhibitors (PPIs) should be prescribed to reduce gastric acid secretion and promote mucosal healing, although there are limited specific data on their use in alcoholic gastritis 1, 3

• H2-receptor antagonists can be used as an alternative to PPIs, though they may be less effective since ethanol-induced damage occurs independent of intraluminal pH 4

• Nutritional therapy is essential as most patients with alcohol-related gastric disorders are malnourished:

  • Provide 35-40 kcal/kg/day and protein intake of 1.2-1.5 g/kg/day 1
  • If three meals per day are insufficient, recommend additional smaller meals 1
  • For severely ill patients, increase protein intake to 1.5 g/kg/day 1

Adjunctive Treatments

• Vitamin and mineral supplementation should be provided alongside nutritional therapy, particularly:

  • Vitamin A, thiamine, vitamin B12, folic acid, pyridoxine, vitamin D, and zinc 1
  • B-complex vitamins are especially important in alcohol users 1

• Sucralfate may be beneficial as a "barrier-acting drug" to protect the damaged gastric mucosa 5

• Testing for Helicobacter pylori should be performed, as H. pylori infection is common in alcoholics and contributes to gastritis 2

  • If H. pylori is detected, appropriate antibiotic treatment should be initiated 2

Management of Complications

• For gastrointestinal bleeding related to alcoholic gastritis:

  • Endoscopic therapy may be necessary for active bleeding 1
  • Angiographic embolization techniques can be considered when endoscopy is not effective 1

• For nausea and vomiting:

  • Dopamine receptor antagonists (prochlorperazine, haloperidol, metoclopramide) 1
  • For persistent symptoms, consider adding 5-HT3 receptor antagonists or anticholinergic agents 1

Behavioral Interventions

• Brief alcohol intervention during hospitalization is strongly recommended to reduce future alcohol consumption 1

  • This has been shown to reduce alcohol intake by approximately 41 g/week 1

• Extended alcohol counseling should be arranged after discharge to maintain abstinence 1

Emerging Treatments

• Research suggests that caspase-1 inhibitors may be promising agents for alcoholic gastritis by reducing pyroptosis (inflammatory cell death) and decreasing inflammatory cytokine release 6

Important Considerations and Pitfalls

• Avoid NSAIDs as they can exacerbate gastric mucosal damage when combined with alcohol 4

• Monitor for nutritional deficiencies which are common in alcoholic patients and can worsen outcomes 1

• Be vigilant for signs of alcohol withdrawal, which may require specific management protocols 1

• Recognize that alcoholic gastritis often coexists with other alcohol-related conditions such as alcoholic liver disease, which may require additional management 1