Treatment for Gastritis
The cornerstone of gastritis treatment is eradication of H. pylori infection (if present) with appropriate antibiotic therapy, combined with acid suppression using proton pump inhibitors (PPIs) such as omeprazole. 1
Diagnosis and Classification
- Gastritis should be confirmed by histopathology with biopsies from both gastric body and antrum/incisura 1
- All patients with gastritis should be tested for H. pylori infection using non-serological testing such as urea breath test or stool antigen test 1, 2
- Two main etiologies of gastritis are H. pylori infection and autoimmunity 1
Treatment Algorithm
Step 1: Test for H. pylori
- For H. pylori-positive gastritis, eradication therapy is essential 1, 2
- Recommended first-line treatment is bismuth quadruple therapy due to increasing clarithromycin resistance 1
- Concomitant 4-drug therapy is an alternative when bismuth is not available 1
- Confirm successful eradication using non-serological testing after treatment 1, 2
Step 2: Acid Suppression Therapy
- Proton pump inhibitors (PPIs) such as omeprazole are the mainstay of treatment 3
- Typical dosing is omeprazole 20mg once daily before a meal 3
- H2-receptor antagonists like ranitidine can be used as an alternative or for milder cases 4, 5
- Famotidine 20mg/day has been shown to significantly reduce epigastric pain, fullness, and heartburn in patients with chronic symptomatic gastritis 5
Step 3: Lifestyle and Dietary Modifications
- Avoid irritants such as alcohol, NSAIDs, and spicy foods 2
- Smaller, more frequent meals may help reduce symptoms 2
Special Considerations
H. pylori and NSAIDs
- H. pylori infection increases the risk of gastroduodenal ulcers in NSAID users 2
- H. pylori eradication is beneficial before starting NSAID treatment and mandatory in patients with a history of peptic ulcer 2
- For patients already on long-term NSAIDs, eradication may be less effective than maintenance PPI therapy for preventing NSAID-associated ulcers 2
Long-term PPI Use
- Long-term PPI treatment in H. pylori-positive patients is associated with corpus-predominant gastritis and accelerated development of atrophic gastritis 2, 6
- Eradication of H. pylori in patients receiving long-term PPIs heals gastritis and prevents progression to atrophic gastritis 2
- Consider H. pylori eradication in patients requiring long-term PPI therapy 2
Autoimmune Gastritis
- For patients with autoimmune gastritis, check antiparietal cell antibodies and anti-intrinsic factor antibodies 1
- Screen for iron and vitamin B-12 deficiencies, especially in corpus-predominant gastritis 1
- Consider endoscopic surveillance every 3 years for advanced atrophic gastritis 1
Bile Reflux Gastritis
- Typically occurs after gastric surgery when pyloric function is compromised 7, 8
- Characterized by epigastric pain, nausea, and bilious vomiting 7, 8
- Conservative therapy including cholestyramine has limited effectiveness 7
- Surgical diversion of duodenal contents (Roux-en-Y procedure) may be necessary in severe cases 7, 8
Monitoring and Follow-up
- Confirm H. pylori eradication 4-8 weeks after completion of therapy 1, 2
- For patients with advanced atrophic gastritis, consider endoscopic surveillance due to increased risk of gastric cancer 1
- H. pylori eradication reduces the risk of gastric cancer development, especially before the development of preneoplastic conditions 1