What is the treatment for gastritis?

Treatment for Gastritis

The treatment for gastritis should focus on addressing the underlying cause, with H. pylori eradication therapy being the primary intervention for H. pylori-positive gastritis, and acid suppression therapy with proton pump inhibitors for symptomatic relief regardless of etiology. 1, 2

Diagnosis and Classification

Before initiating treatment, it's important to identify the type of gastritis:

• Gastritis should be confirmed by histopathology, with biopsies from both the gastric body and antrum/incisura 1
• All patients with gastritis should be assessed for H. pylori infection using non-serological testing modalities 1
• Two main etiologies of gastritis are H. pylori infection and autoimmunity 1

Treatment Algorithm

Step 1: H. pylori Eradication (if positive)

• For H. pylori-positive gastritis, eradication therapy is the cornerstone of treatment 1
• Bismuth quadruple therapy is recommended as first-line treatment due to increasing clarithromycin resistance 1
• Concomitant 4-drug therapy is an alternative when bismuth is not available 1
• Successful eradication should be confirmed using non-serological testing 1

Step 2: Acid Suppression Therapy

• Proton pump inhibitors (PPIs) such as omeprazole are indicated for:
  • Healing of duodenal ulcers (up to 8 weeks) 2
  • Treatment of GERD symptoms (up to 4 weeks) 2
  • Healing of erosive esophagitis (up to 8 weeks) 2
• H2-receptor antagonists like ranitidine can be used as an alternative:
  • For short-term treatment of active duodenal ulcer 3
  • For treatment of GERD 3
  • For treatment of erosive esophagitis 3

Step 3: Specific Management Based on Gastritis Type

For Atrophic Gastritis:

• Evaluate for iron and vitamin B-12 deficiencies, especially if corpus-predominant 1
• Consider endoscopic surveillance every 3 years for advanced atrophic gastritis 1
• For autoimmune gastritis, screen for concomitant autoimmune disorders, particularly thyroid disease 1

For Erosive/Hemorrhagic Gastritis:

• Identify and address underlying predisposing conditions (alcohol abuse, NSAID use, etc.) 4
• Provide supportive measures and therapy directed toward healing mucosal damage 4

Special Considerations

• PPIs should be prescribed at the lowest effective dose for the shortest duration needed 2

• Monitor for potential PPI side effects including:

  • Tubulointerstitial nephritis 2
  • Clostridium difficile-associated diarrhea 2
  • Bone fractures with long-term use 2
  • Certain types of lupus erythematosus 2

• For patients with autoimmune gastritis:

  • Consider checking antiparietal cell antibodies and anti-intrinsic factor antibodies 1
  • Screen for type 1 gastric neuroendocrine tumors with upper endoscopy 1

Duration of Treatment

• For H. pylori eradication: 10-14 days of antibiotic therapy 1, 2
• For acid suppression with PPIs:
  • 4-8 weeks for symptom relief and healing 2
  • Longer-term treatment may be needed for certain conditions, but risks increase with duration 2

Prevention Strategies

• H. pylori eradication reduces the risk of gastric cancer development, especially before the development of preneoplastic conditions 1
• Risk stratification of patients with premalignant gastric conditions should be based on the severity and distribution of lesions 1
• Patients with risk factors for gastric cancer should be considered for H. pylori eradication even if asymptomatic 1