Medical Treatment for 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
PPI Therapy
- High-potency PPIs are recommended as first-line treatment for gastritis 1
- Recommended PPI options and dosages:
- Pantoprazole should be avoided when possible due to lower potency (40 mg pantoprazole equivalent to only 9 mg omeprazole) 1
- PPIs should be taken 30 minutes before meals for optimal effectiveness 1
H2-Receptor Antagonists
- Ranitidine can be used as an alternative to PPIs at a dose of 150 mg twice daily 2
- For gastric ulcers, the recommended dose is 150 mg twice daily 2
- For maintenance therapy, 150 mg at bedtime is recommended 2
Treatment for H. pylori-Associated Gastritis
H. pylori infection is a common cause of gastritis that requires specific treatment:
- Bismuth quadruple therapy for 14 days is the preferred first-line treatment due to increasing antibiotic resistance 1
- Concomitant 4-drug therapy is an alternative when bismuth is unavailable 1
- Triple therapy options (clarithromycin, metronidazole, or levofloxacin-based) should be guided by local resistance patterns 1
- Higher-potency PPIs improve H. pylori eradication rates 1
- Testing for H. pylori should be performed using non-invasive tests such as urea breath test or monoclonal stool antigen tests 1
Antibiotics for H. pylori
- Antibiotics in the "Access group" (amoxicillin, tetracycline, and metronidazole) have lower resistance potential 3
- Eradication therapy should be administered for 14 days to maximize effectiveness 3
- H. pylori eradication provides a significant improvement in symptom resolution compared to placebo 3
Treatment for NSAID-Induced Gastritis
- Use the lowest effective NSAID dose for the shortest duration to minimize risk 1
- Add PPI therapy for gastroprotection in high-risk patients taking NSAIDs 1
- Consider H. pylori eradication before starting long-term NSAID therapy 1
- Misoprostol reduces NSAID-associated gastric ulcers by 74% but has side effects including diarrhea and abdominal pain 1
Adjunctive Treatments
- Antacids provide rapid, temporary relief of symptoms and can be used on-demand for breakthrough symptoms 1
- For patients with residual symptoms after successful H. pylori eradication, full-dose PPI therapy is recommended 1
Special Considerations
Effect of PPIs on H. pylori Gastritis
- PPIs can reduce H. pylori numbers and urease activity in vivo 4
- In H. pylori-positive patients, long-term PPI treatment is associated with corpus-predominant gastritis 1, 5
- PPIs may cause a shift in the distribution of gastritis from antrum to corpus in H. pylori-infected patients 5, 6
Common Pitfalls to Avoid
- Inadequate PPI dosing and premature discontinuation of treatment 1
- Failure to address H. pylori infection when present 1
- Relying solely on symptom resolution without confirming H. pylori eradication 1
- Insufficient duration of antibiotic therapy for H. pylori (should be 14 days) 3
Follow-up and Monitoring
- Confirm H. pylori eradication after treatment with non-invasive testing 1
- Gradual improvement of symptoms with fluctuations is expected with appropriate treatment 1
- For persistent symptoms despite appropriate therapy, consider endoscopic evaluation to rule out other causes 1
By following these evidence-based recommendations, most patients with gastritis can achieve symptom relief and healing of gastric inflammation, while preventing complications such as ulcers and reducing the risk of gastric cancer in H. pylori-infected individuals.