From the Guidelines
For gastritis management, proton pump inhibitors (PPIs) are generally considered first-line therapy due to their superior acid suppression, as evidenced by the most recent study in 2022 1.
Gastritis Management Options
Both PPIs and H2 blockers are effective options for managing gastritis, with PPIs being the preferred choice due to their ability to provide more potent acid suppression.
- Common PPIs include omeprazole (20-40mg daily), esomeprazole (20-40mg daily), pantoprazole (40mg daily), and lansoprazole (30mg daily), typically taken 30 minutes before breakfast for 4-8 weeks.
- H2 blockers like famotidine (20mg twice daily), ranitidine (150mg twice daily), and cimetidine (400mg twice daily) are alternatives for those who cannot tolerate PPIs or have milder symptoms.
Mechanism of Action
PPIs work by blocking the hydrogen-potassium ATPase enzyme in gastric parietal cells, preventing the final step of acid production, while H2 blockers competitively inhibit histamine receptors on parietal cells, reducing acid secretion less completely than PPIs 2.
Lifestyle Modifications and Additional Considerations
Lifestyle modifications should accompany medication therapy, including avoiding NSAIDs, alcohol, spicy foods, caffeine, and smoking.
- For H. pylori-associated gastritis, triple or quadruple therapy combining antibiotics with a PPI is necessary, as highlighted in a 2019 study 3.
- Patients should be advised that PPIs may cause headache, diarrhea, or vitamin B12 deficiency with long-term use, while H2 blockers may cause headache, dizziness, or constipation.
- A 2022 study 1 also notes that in patients with a known history of more severe erosive esophagitis or those with GERD-related complications, PPIs should generally not be considered for discontinuation unless the benefits and harms have been weighed and discussed with the patient.
From the FDA Drug Label
Lansoprazole belongs to a class of antisecretory compounds, the substituted benzimidazoles, that suppress gastric acid secretion by specific inhibition of the (H +, K +)-ATPase enzyme system at the secretory surface of the gastric parietal cell Famotidine is a competitive inhibitor of histamine-2 (H2) receptors. The primary clinically important pharmacologic activity of famotidine is inhibition of gastric secretion.
The roles of Proton Pump Inhibitors (PPI) and Histamine-2 (H2) blockers in the management of gastritis are:
- PPIs, such as lansoprazole, suppress gastric acid secretion by inhibiting the (H +, K +)-ATPase enzyme system, thereby reducing gastric acid production.
- H2 blockers, such as famotidine, inhibit gastric secretion by competitively inhibiting histamine-2 receptors, thereby reducing gastric acid production. These mechanisms of action help to reduce gastric acid secretion, which can help to manage gastritis by reducing inflammation and promoting healing of the gastric mucosa 4, 5.
From the Research
Roles of Proton Pump Inhibitors (PPI) and Histamine-2 (H2) blockers in Gastritis Management
- PPIs are the most potent gastric acid-suppressing agents, with improved efficacy over H2 receptor antagonists in acid-related disorders 6
- PPIs, such as omeprazole, lansoprazole, pantoprazole, and rabeprazole, are effective in healing duodenal and gastric ulcers, with standard doses being more effective than H2-receptor antagonists 6, 7
- H2 blockers, such as ranitidine, are effective in healing gastric and duodenal ulcers, but may have a lower healing rate compared to PPIs, especially in patients continuing to take non-steroidal anti-inflammatory drugs (NSAIDs) 7
- Combination therapy with PPIs and H2 blockers may not provide additional benefits in controlling nocturnal acid breakthrough or improving symptoms in patients with gastroesophageal reflux disease (GERD) 8
Comparison of PPIs and H2 Blockers
- PPIs have been shown to have higher healing rates than H2 blockers, such as ranitidine, in the treatment of gastric ulcers 9
- Newer PPIs, such as lansoprazole, pantoprazole, and rabeprazole, may have a faster onset of action and improved symptom relief compared to older PPIs, such as omeprazole 9, 10
- All PPIs, including lansoprazole, omeprazole, pantoprazole, and rabeprazole, have similar potency and efficacy in inhibiting gastric acid secretion 10
Clinical Applications
- PPIs are the treatment of choice for the management of gastric acid hypersecretion in Zollinger-Ellison syndrome 6
- PPIs are effective in healing ulcers and reducing symptoms in patients with GERD, and may be used in combination with antibacterials to eradicate Helicobacter pylori in patients with duodenal or gastric ulcers 6, 7