From the Guidelines
In the UK, management of atrophic gastritis should prioritize Helicobacter pylori eradication, vitamin B12 supplementation, and endoscopic surveillance every 3 years for patients with extensive atrophic gastritis or intestinal metaplasia, as these measures can significantly reduce the risk of gastric cancer and improve patient outcomes. The approach to managing atrophic gastritis involves a combination of diagnosis, treatment, and surveillance. Initial management includes Helicobacter pylori eradication if present, using a 7-day triple therapy regimen such as amoxicillin 1g twice daily, clarithromycin 500mg twice daily, and a proton pump inhibitor (PPI) like omeprazole 20mg twice daily, as recommended by recent guidelines 1. For patients with autoimmune atrophic gastritis, vitamin B12 supplementation is essential, typically administered as hydroxocobalamin 1mg intramuscular injections every three months for life, to prevent malabsorption of essential nutrients and related complications 1. Iron supplementation may also be required, with ferrous sulfate 200mg twice daily being commonly prescribed. PPIs like omeprazole 20-40mg daily can help manage symptoms in patients with persistent dyspepsia.
Key Components of Care
- Helicobacter pylori eradication
- Vitamin B12 supplementation for patients with autoimmune atrophic gastritis
- Iron supplementation as needed
- PPIs for symptom management
- Endoscopic surveillance every 3 years for patients with extensive atrophic gastritis or intestinal metaplasia, as supported by the most recent and highest quality study 1
The rationale for this approach is that atrophic gastritis, whether caused by H. pylori infection or autoimmune processes, leads to reduced gastric acid production and intrinsic factor, potentially resulting in malabsorption of essential nutrients and an increased risk of gastric neoplasia. By prioritizing these measures, healthcare providers can improve patient outcomes and reduce the risk of complications associated with atrophic gastritis. Nutritional assessment and management of pernicious anemia are also important components of care, as emphasized in recent clinical practice updates 1.
From the Research
UK Guidelines for Managing Atrophic Gastritis
There are no specific UK guidelines mentioned in the provided studies for managing atrophic gastritis.
General Information on Atrophic Gastritis
- Atrophic gastritis is a condition where the stomach lining has become inflamed and has lost its glandular cells and their eventual replacement with intestinal and fibrous tissues 2, 3, 4.
- The use of proton pump inhibitors (PPIs) has been associated with an increased risk of atrophic gastritis, particularly in patients with Helicobacter pylori infection 3, 5.
- Some studies suggest that the use of antacids and H2 receptor antagonists may not increase the incidence of atrophic gastritis in patients with or without H. pylori gastritis 4.
- Research on alternative therapeutics using food or food-based products for the treatment of gastritis is ongoing, with some studies showing potential benefits of certain foods such as garlic, turmeric, and probiotics 6.
Treatment and Management
- Treatment for atrophic gastritis typically involves addressing the underlying cause, such as H. pylori infection, and managing symptoms with medications such as PPIs or H2 receptor antagonists 3, 5.
- Some studies suggest that regular consumption of fortified foods may help enhance vitamin B-12 status in patients with atrophic gastritis, but more research is needed to confirm this 2.