What is the treatment for gastritis?

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 = 9 mg omeprazole)

• PPIs should be taken 30 minutes before meals to maximize effectiveness 2

• Treatment duration typically ranges from 4-8 weeks depending on symptom severity and response 2

Treatment Algorithm Based on Gastritis Type

H. pylori-Associated Gastritis

1. Test for H. pylori using urea breath test or monoclonal stool antigen test 3

2. If positive, initiate eradication therapy:

   • First-line: Bismuth quadruple therapy for 14 days 1
   • Alternative: Concomitant 4-drug therapy when bismuth is unavailable 1
   • Use higher-potency PPIs (rabeprazole or esomeprazole) to improve eradication rates 1, 4

3. Confirm eradication after therapy to prevent complications 1

NSAID-Induced Gastritis

1. Discontinue or reduce NSAID use when possible 1
2. Initiate PPI therapy at standard doses 1
3. Consider H. pylori testing and eradication before starting long-term NSAID therapy 3, 1
4. For patients requiring continued NSAID therapy, add gastroprotection with PPIs 1

Stress-Related Gastritis

1. Start with high-dose PPI therapy 1
2. Address underlying causes of stress when possible
3. Consider antacids for breakthrough symptoms 1

Management of Persistent Symptoms

• For patients with residual symptoms following H. pylori eradication, continue PPI therapy (e.g., pantoprazole 40 mg daily) 1

• H. pylori eradication produces long-term relief of dyspepsia in approximately 1 in 12 patients with functional dyspepsia, with a number needed to treat of 12 3

• For patients with recurring symptoms after H. pylori eradication, treatment should be individualized based on predominant symptoms 1

Special Considerations and Pitfalls

• Long-term PPI treatment in H. pylori-positive patients is associated with corpus-predominant gastritis, which accelerates progression to atrophic gastritis 3

• Eradication of H. pylori in patients receiving long-term PPIs heals gastritis and prevents progression to atrophic gastritis 3

• Common pitfalls to avoid 1:

  • Inadequate PPI dosing (timing relative to meals)
  • Premature discontinuation of treatment
  • Failure to address H. pylori infection
  • Relying solely on symptom resolution without confirming H. pylori eradication

• PPIs may interact with certain medications; for example, clarithromycin (used in H. pylori eradication) can increase serum carbamazepine levels 5

• Omeprazole at standard doses (20 mg twice daily) alone is ineffective for H. pylori eradication, with studies showing 0% eradication rates after 6 months 6

• Higher doses of omeprazole (40-60 mg twice daily) combined with antibiotics significantly improve H. pylori eradication rates 4