What are the management options for gastritis?

From the Guidelines

Management of gastritis involves both medication and lifestyle changes to reduce stomach inflammation and promote healing, with the most recent and highest quality study 1 suggesting that eradication of H. pylori infection is crucial in preventing gastric cancer and other complications. For acute gastritis, I recommend a short course of proton pump inhibitors (PPIs) such as omeprazole 20mg once daily or pantoprazole 40mg once daily for 4-8 weeks. If H. pylori infection is present, triple therapy is necessary: a PPI twice daily plus amoxicillin 1g twice daily and clarithromycin 500mg twice daily for 14 days, as recommended by the most recent study 1. For symptom relief, antacids like aluminum hydroxide/magnesium hydroxide can be taken as needed. Patients should avoid gastric irritants including alcohol, NSAIDs, spicy foods, caffeine, and tobacco. Eating smaller, more frequent meals and staying upright for 2-3 hours after eating helps reduce acid reflux. Stress reduction techniques are also beneficial as stress can worsen gastritis symptoms. For chronic gastritis, long-term acid suppression may be necessary, with regular monitoring for vitamin B12 deficiency, especially in atrophic gastritis, as suggested by 1. These treatments work by either neutralizing stomach acid, reducing acid production, eliminating H. pylori bacteria, or protecting the stomach lining, allowing the inflamed gastric mucosa to heal and preventing complications like ulcers or bleeding.

Some key points to consider in the management of gastritis include:

• The importance of eradication of H. pylori infection in preventing gastric cancer and other complications, as highlighted by 1 and 1
• The use of PPIs and triple therapy in the treatment of H. pylori infection, as recommended by 1 and 1
• The need for lifestyle changes, such as avoiding gastric irritants and eating smaller, more frequent meals, to reduce symptoms and promote healing
• The importance of regular monitoring for vitamin B12 deficiency in patients with chronic gastritis, especially in atrophic gastritis, as suggested by 1

Overall, the management of gastritis requires a comprehensive approach that includes medication, lifestyle changes, and regular monitoring to prevent complications and promote healing, with the most recent and highest quality study 1 guiding treatment decisions.

From the FDA Drug Label

Adult Patients only Helicobacter pylori Infection and Duodenal Ulcer Disease: Triple therapy for Helicobacter pylori (H. pylori) with clarithromycin and lansoprazole : Amoxicillin, in combination with clarithromycin plus lansoprazole as triple therapy, is indicated for the treatment of patients with H pylori infection and duodenal ulcer disease (active or 1-year history of a duodenal ulcer) to eradicate H. pylori. Dual therapy for H. pylori with lansoprazole : Amoxicillin, in combination with lansoprazole delayed-release capsules as dual therapy, is indicated for the treatment of patients with H pylori infection and duodenal ulcer disease (active or 1-year history of a duodenal ulcer) who are either allergic or intolerant to clarithromulin or in whom resistance to clarithromulin is known or suspected.

The management options for gastritis include:

• Eradication of H. pylori using triple therapy with amoxicillin, clarithromarin, and lansoprazole, or dual therapy with amoxicillin and lansoprazole for patients who are allergic or intolerant to clarithromarin 2.
• Treatment with ranitidine for short-term treatment of active, benign gastric ulcer, and maintenance therapy for gastric ulcer patients at reduced dosage after healing of acute ulcers 3.

From the Research

Management Options for Gastritis

The management options for gastritis, particularly in the context of Helicobacter pyli infection, include various pharmacological approaches.

• Proton Pump Desensitors and Antibaders: First-line therapy for H. pylori infection often involves a combination of a proton pump inhibitor (PPI) and two antibiotics, such as clarithromycin and amoxicillin, or bismuth quadruple therapy 4.
• Eradication Therapy: The goal of therapy is complete eradication of H. pylori, which can lead to gastritis, gastric and duodenal ulcers, and gastric cancer 4.
• Treatment Duration and Ulcer Size: The duration of treatment and the size of the ulcer are important factors in determining the effectiveness of therapy. For example, one-week triple therapy may be sufficient for small ulcers (< 1.0 cm), but larger ulcers (> 1.5 cm) may require longer treatment durations and follow-up therapy to suppress acid 5.
• Sequential Treatment and Quadruple Therapy: Recent developments in treatment options include the use of sequential treatment, which involves a combination of a PPI, clarithromycin, amoxicillin, and metronidazole, as well as quadruple therapy as first-line therapy 6.
• Considerations for Special Populations: Treatment selection can be challenging in special populations, such as patients with penicillin allergies, patients with or at risk for QTc-interval prolongation, and patients who are pregnant, breastfeeding, or elderly 4.

Treatment Strategies

Treatment strategies for H. pylori infection often involve a combination of therapies, including:

• First-line Therapy: Typically involves a triple therapy combination of a PPI, clarithromycin, and amoxicillin, or bismuth quadruple therapy 4, 6.
• Second-line Therapy: May involve a quadruple therapy combination of a PPI, metronidazole, tetracycline, and a bismuth salt for treatment failures 6.
• Sequential Treatment: A newly devised combination of a PPI, clarithromycin, amoxicillin, and metronidazole, which has shown promise in recent studies 6.