What is the treatment for gastritis without diarrhea?

Treatment of Gastritis Without Diarrhea

For gastritis without diarrhea, test for and eradicate Helicobacter pylori infection if present, as this provides long-term symptom relief and prevents progression to atrophic gastritis and gastric cancer. 1

Primary Treatment Approach: H. pylori Testing and Eradication

Initial Diagnostic Strategy

• Test all patients with gastritis for H. pylori using non-invasive methods: urea breath test (UBT) or monoclonal stool antigen tests are first-line options 1
• Validated serological tests can also be used for initial screening 1
• H. pylori eradication produces long-term relief of dyspepsia in approximately 1 in 12 patients with functional dyspepsia, which is superior to any other treatment option 1

Eradication Therapy Benefits

H. pylori eradication is the cornerstone of gastritis management because it:

• Resolves inflammation and normalizes gastric function 2
• May reverse atrophic and metaplastic changes of the gastric mucosa 2
• Prevents progression to gastric cancer 2
• Reduces dyspepsia consultations by 25% between 2-7 years of follow-up 1

Treatment Regimen Selection

• Complex multidrug regimens are required to achieve eradication rates of approximately 90% 2
• The specific antibiotic combination should be selected based on local resistance patterns 2
• Factors associated with treatment failure include high bacterial load, high gastric acidity, smoking, low compliance, overweight, and increasing antibiotic resistance 2

Management of NSAID-Related Gastritis

If NSAID Use is Identified

• Discontinue NSAIDs if possible, as they are a primary cause of gastric erosions and ulcers 3, 4
• Approximately 10-30% of regular NSAID users develop gastric ulcers 3
• If NSAIDs must be continued, consider cotherapy with misoprostol to decrease the incidence of gastric and duodenal ulcers 3
• Eradicate H. pylori in NSAID users with a history of peptic ulcer, as this prevents gastropathy 1

Symptomatic Management for Non-H. pylori, Non-NSAID Gastritis

For Dyspeptic Symptoms

When H. pylori is absent or already eradicated and symptoms persist:

• Avoid proton pump inhibitors (PPIs) in atrophic gastritis or autoimmune gastritis, as these patients already have achlorhydria and acid suppression is useless 5
• For confirmed gastroesophageal reflux (verified by pH-impedance testing), use mechanical prevention: elevation of head of bed and alginates 5
• Consider antireflux surgery for severe reflux symptoms in atrophic gastritis 5

Emerging Therapies

• Probiotics (Lactobacillus and Bifidobacterium species) show potential for healing gastric ulcers by regulating immune response, reducing inflammation, and restoring balance between defensive and aggressive factors 4
• Yeast probiotics may be particularly useful in patients receiving antibacterial therapy due to natural resistance to antibacterial antibiotics 4

Special Considerations for Atrophic Gastritis

Acid Replacement Therapy

• In atrophic gastritis with dyspepsia, consider a trial of gastric acidification therapy (oral acid administration), though randomized controlled trials are lacking 5
• This approach is based on historical use with reported success for "aiding digestion" 5

Monitoring and Prevention

• Severe atrophic gastritis and acid-free stomach represent the highest independent risk conditions for gastric cancer 6
• Monitor for malabsorption of vitamin B12, iron, calcium, magnesium, and zinc in severe atrophic gastritis 6

Critical Pitfalls to Avoid

• Never prescribe acid suppressants for autoimmune or atrophic gastritis—these patients cannot secrete acid, making PPIs completely ineffective 5
• Do not assume symptom resolution means H. pylori eradication; confirm eradication with post-treatment testing 1
• Recognize that NSAIDs do not cause inflammatory cell infiltration (true histologic gastritis)—any such gastritis is due to H. pylori infection 3
• In patients with corpus-predominant atrophic gastritis, standard PPI-based H. pylori eradication regimens may be less effective due to reduced gastric acid secretion; consider bismuth-based therapy instead 2