What is the treatment for gastritis?

Treatment of Gastritis

High-potency proton pump inhibitors (PPIs) are the first-line treatment for gastritis, with options like esomeprazole (20-40 mg twice daily) or rabeprazole (20 mg twice daily) being most effective for symptom relief and healing. 1

First-Line Treatment Options

• PPIs are the cornerstone of gastritis treatment, with high-potency options providing superior symptom relief and mucosal healing 1, 2
• Recommended PPI options and dosages include:
  • Rabeprazole: 20 mg twice daily 2
  • Esomeprazole: 20-40 mg twice daily 2
  • Lansoprazole: 30 mg twice daily 2
• PPIs should be taken 30 minutes before meals for optimal effectiveness 1, 2
• Pantoprazole should be avoided when possible due to lower potency 2

Treatment Based on Gastritis Etiology

H. pylori-Associated Gastritis

• All individuals with gastritis should be assessed for H. pylori infection 3
• If H. pylori positive, eradication therapy should be administered and successful eradication confirmed using non-serological testing 3, 1
• Bismuth quadruple therapy for 14 days is the preferred first-line treatment due to increasing antibiotic resistance 1, 2
• Concomitant 4-drug therapy is an alternative when bismuth is unavailable 1, 2
• Higher-potency PPIs improve H. pylori eradication rates 1, 2
• H. pylori eradication heals gastritis and prevents progression to atrophic gastritis in patients receiving long-term PPIs 3

NSAID-Induced Gastritis

• Use the lowest effective NSAID dose for the shortest duration to minimize risk 1, 2
• Add PPI therapy for gastroprotection in high-risk patients taking NSAIDs 1, 2
• H. pylori eradication is beneficial and should be performed before starting NSAID treatment, especially in patients with a history of peptic ulcers 3, 1
• Misoprostol reduces NSAID-associated gastric ulcers by 74% but has side effects including diarrhea and abdominal pain 2

Autoimmune Gastritis

• Check antiparietal cell antibodies and anti-intrinsic factor antibodies to assist with diagnosis 3
• Evaluate for anemia due to vitamin B-12 and iron deficiencies 3
• Screen for concomitant autoimmune disorders, particularly autoimmune thyroid disease 3

Adjunctive Treatments

• Antacids provide rapid, temporary relief of symptoms and can be used on-demand for breakthrough symptoms 1, 2
• For patients with residual symptoms after successful H. pylori eradication, full-dose PPI therapy is recommended 2

Follow-up and Monitoring

• Confirm H. pylori eradication after treatment with non-invasive testing such as urea breath test or monoclonal stool antigen tests 1, 2
• For persistent symptoms despite appropriate therapy, consider endoscopic evaluation to rule out other causes 1
• Surveillance endoscopy every 3 years should be considered in individuals with advanced atrophic gastritis 3
• For autoimmune gastritis, interval endoscopic surveillance should be considered based on individualized risk assessment 3

Common Pitfalls to Avoid

• Inadequate PPI dosing and premature discontinuation of treatment 1, 2
• Failure to address H. pylori infection when present 1, 2
• Relying solely on symptom resolution without confirming H. pylori eradication 1, 2
• Insufficient duration of antibiotic therapy for H. pylori (should be 14 days) 1
• Failure to evaluate for vitamin B-12 and iron deficiencies in patients with atrophic gastritis 3