Treatment of Gastritis
Proton pump inhibitors (PPIs) are the first-line treatment for gastritis, with high-potency options like esomeprazole or rabeprazole (20-40 mg twice daily) being most effective for symptom relief and healing. 1
First-Line Treatment Options
PPIs are the cornerstone of gastritis treatment, with the following recommended dosages 1:
- Rabeprazole: 20 mg twice daily (equivalent to 36 mg omeprazole)
- Esomeprazole: 20-40 mg twice daily (equivalent to 32 mg omeprazole)
- Lansoprazole: 30 mg twice daily (equivalent to 27 mg omeprazole)
Pantoprazole should be avoided when possible due to lower potency (40 mg pantoprazole is equivalent to only 9 mg omeprazole) 1
Antacids can be used as adjunctive therapy for rapid, temporary relief of breakthrough symptoms 1
H2-receptor antagonists like ranitidine can be used as an alternative, with a recommended dose of 150 mg twice daily for gastric ulcers and gastritis 2
Treatment for H. pylori-Associated Gastritis
Testing for H. pylori should be performed using non-invasive tests such as urea breath test (UBT) or monoclonal stool antigen tests 3
Bismuth quadruple therapy for 14 days is the preferred first-line treatment for H. pylori-associated gastritis due to increasing antibiotic resistance 1
Concomitant 4-drug therapy is an alternative first-line option when bismuth is unavailable 1
Higher-potency PPIs (rabeprazole or esomeprazole) improve H. pylori eradication rates compared to standard-dose PPIs 1, 4
H. pylori eradication produces long-term relief of dyspepsia in approximately 1 in 12 patients with functional dyspepsia 3
Special Considerations
NSAID-Associated Gastritis
Use the lowest effective NSAID dose for the shortest duration to minimize the risk of NSAID-induced gastritis 1
PPI therapy should be added for gastroprotection in high-risk patients taking NSAIDs 1
H. pylori eradication is beneficial and should be performed before starting NSAID treatment, especially in patients with a history of peptic ulcers 3
Misoprostol can reduce NSAID-associated gastric ulcers by 74% but its use is limited by side effects such as diarrhea and abdominal pain 1
Long-term PPI Use and H. pylori
Long-term PPI treatment in H. pylori-positive patients is associated with the development of corpus-predominant gastritis, which accelerates the progression to atrophic gastritis 3
Eradication of H. pylori in patients receiving long-term PPIs heals gastritis and prevents progression to atrophic gastritis 3, 5
PPIs possess some antibacterial activity against H. pylori in vitro, with lansoprazole showing the strongest effect, followed by omeprazole, with pantoprazole being the least effective 6
Common Pitfalls to Avoid
Inadequate PPI dosing and premature discontinuation of treatment can lead to treatment failure 1
Failure to test for and address H. pylori infection is a common reason for persistent or recurrent gastritis 1
Using pantoprazole as first-line therapy may result in suboptimal acid suppression due to its lower potency compared to other PPIs 1
Relying solely on symptom resolution without confirming H. pylori eradication can lead to persistent infection and complications 3
Omeprazole alone at standard doses (40 mg/day) is ineffective for H. pylori eradication and should always be combined with appropriate antibiotics when treating H. pylori-associated gastritis 7, 8