What is the recommended treatment for gastritis in children?

Treatment of Gastritis in Children

The recommended first-line treatment for gastritis in children consists of lifestyle modifications, including dietary changes and feeding modifications, before considering pharmacologic interventions. 1

Initial Management Approach

• Lifestyle modifications should be implemented as the first step in managing gastritis in children:
  • Dietary changes: avoid trigger foods (spicy foods, chocolate, caffeine, acidic foods) 1
  • Feeding modifications: reduce meal size, increase meal frequency, avoid eating 2-3 hours before bedtime 1
  • Positioning: keep child upright for at least 30 minutes after meals 1
  • For infants: consider maternal elimination diet (if breastfed) or hydrolyzed protein formula (if formula-fed) 2
  • For infants: thickening feedings with rice cereal may help reduce symptoms 2

Pharmacologic Therapy

• If symptoms persist after 2-4 weeks of lifestyle modifications, consider pharmacologic therapy 1:

1. Acid Suppressants:

   • H2 Receptor Antagonists (H2RAs):

     • Ranitidine: 5-10 mg/kg/day divided in 2-3 doses 3, 4
     • For GERD treatment in children: 5-10 mg/kg/day, usually given in 2 divided doses 4

   • Proton Pump Inhibitors (PPIs):

     • Initial trial of PPIs for 2 weeks 3
     • If symptoms improve, continue for 8-12 weeks 3
     • If relapse occurs, consultation with pediatric gastroenterologist is recommended 3
     • Dosage examples:
       • Omeprazole: 0.7-3.3 mg/kg/day 3
       • Lansoprazole: 0.7-3 mg/kg/day 3

2. Antacids:

   • May provide on-demand relief of symptoms 3
   • Not recommended for chronic therapy due to potential risks 1

Special Considerations

• For H. pylori-associated gastritis:

  • Diagnosis should be based on upper endoscopy, not "test and treat strategy" 5
  • Treatment should be tailored based on antimicrobial susceptibility testing 5
  • Aim for eradication rates above 90% 5

• For eosinophilic gastritis:

  • Consider food elimination diet plus PPI therapy as first-line treatment 6
  • Younger children may respond better to this approach 6
  • For non-responders, topical corticosteroids (oral viscous budesonide) may be considered 6

Monitoring and Follow-up

• Evaluate response to therapy after 4-8 weeks 1
• If symptoms persist despite appropriate therapy, consider:
  • Further evaluation with upper endoscopy and esophageal biopsy 1
  • Referral to pediatric gastroenterology 3, 1

Important Pitfalls to Avoid

• Avoid overtreatment with acid suppressants, particularly PPIs, due to potential risks including community-acquired pneumonia, gastroenteritis, and candidemia 1
• In infants with uncomplicated regurgitation ("happy spitters"), avoid medications and focus on parental education and reassurance 3
• Weight loss is a crucial warning sign that should alter clinical management in infants 3
• Be aware that many clinical conditions may mimic GERD symptoms, so careful follow-up of all treated patients is essential 3