What is the treatment for Gastritis Alcoholica?

Treatment of Alcoholic Gastritis

Complete alcohol abstinence is the primary and most fundamental treatment for alcoholic gastritis, which must be combined with proton pump inhibitors, nutritional support, and management of associated symptoms. 1

First-Line Interventions

• Alcohol abstinence is essential as continued alcohol consumption perpetuates mucosal damage and inflammation in the gastric lining 1
• Proton pump inhibitors (PPIs) such as omeprazole should be prescribed to reduce gastric acid secretion and promote mucosal healing 1, 2
• PPIs should be taken before meals for optimal effect, with the lowest effective dose for the shortest time needed to minimize side effects 2
• Nutritional therapy providing 35-40 kcal/kg/day and protein intake of 1.2-1.5 g/kg/day is recommended to support healing 1
• For severely ill patients, protein intake should be increased to 1.5 g/kg/day 1

Vitamin and Mineral Supplementation

• B-complex vitamins are especially important in alcohol users due to common deficiencies 1
• Supplement with vitamin A, thiamine, vitamin B12, folic acid, pyridoxine, vitamin D, and zinc 1
• Monitor for cyanocobalamin (vitamin B-12) deficiency, which can occur with long-term PPI use (longer than 3 years) 2
• Consider monitoring magnesium levels in patients on prolonged PPI treatment, as hypomagnesemia can occur 2

Management of Complications

• For gastrointestinal bleeding related to alcoholic gastritis, endoscopic therapy may be necessary 1
• Angiographic embolization techniques can be considered when endoscopy is not effective 1
• For nausea and vomiting, dopamine receptor antagonists (prochlorperazine, haloperidol, metoclopramide) can be used 1
• For persistent symptoms, consider adding 5-HT3 receptor antagonists or anticholinergic agents 1

Helicobacter pylori Testing and Treatment

• Test for Helicobacter pylori infection, which is common in alcoholics and can exacerbate gastritis 3
• Eradication of H. pylori with appropriate antibiotic therapy should be considered in positive cases 3
• Studies have shown that antibiotic treatment for H. pylori results in histological and symptomatic improvement in the majority of patients with alcoholic gastritis 3

Behavioral Interventions

• Brief alcohol intervention during hospitalization is strongly recommended to reduce future alcohol consumption 1
• This intervention 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
• For patients with severe alcohol-related conditions, referral to specialized addiction treatment programs is recommended 4

Important Considerations and Pitfalls

• Avoid prolonged PPI use when possible, as it may lead to increased risk of fundic gland polyps, especially beyond one year of treatment 2
• Be vigilant for signs of alcohol withdrawal, which may require specific management protocols 1
• Monitor for potential PPI side effects including diarrhea (possibly from Clostridium difficile), bone fractures with long-term use, and certain types of lupus erythematosus 2
• Recognize that alcoholic gastritis often coexists with other alcohol-related conditions, such as alcoholic liver disease, which may require additional management 1
• Avoid concomitant use of PPIs with clopidogrel, as PPIs can reduce clopidogrel's effectiveness 2
• Be aware of potential drug interactions between PPIs and medications such as methotrexate, St. John's Wort, or rifampin 2

Emerging Research

• Recent research suggests that pyroptosis (a form of inflammatory cell death) may be involved in the pathogenesis of alcohol-induced gastritis 5
• Caspase-1 inhibitors have shown promise in experimental models for decreasing alcohol-induced gastric damage 5