From the Research
Gastritis presents with a range of symptoms including epigastric pain, nausea, vomiting, early satiety, and occasionally hematemesis or melena in severe cases, and its management should prioritize H. pylori eradication and symptom relief to improve morbidity, mortality, and quality of life. The pain is typically burning or gnawing in nature and may worsen after meals. Patients often report bloating, indigestion, and loss of appetite. Acute gastritis develops suddenly and can be caused by NSAIDs, alcohol, stress, or certain infections, while chronic gastritis develops gradually and is commonly associated with H. pyli infection or autoimmune conditions.
Diagnosis and Treatment
Diagnosis involves clinical evaluation, endoscopy with biopsy, H. pylori testing, and sometimes blood tests to check for anemia or autoimmune markers. Treatment depends on the cause but typically includes proton pump inhibitors (like omeprazole 20-40mg daily or pantoprazole 40mg daily) for 4-8 weeks, H. pylori eradication therapy if positive (clarithromycin 500mg, amoxicillin 1g, and PPI twice daily for 14 days), avoiding irritants like NSAIDs and alcohol, and dietary modifications, as supported by studies such as 1 and 2. Antacids may provide temporary symptom relief. Severe cases with bleeding may require hospitalization for IV fluids, proton pump inhibitors, and possibly endoscopic intervention.
Considerations for H. pylori Infection
It is crucial to note that H. pylori infection is a significant risk factor for gastritis, peptic ulcer, and gastric cancer, as highlighted in studies such as 3. The use of proton pump inhibitors can sometimes mask H. pylori infections, leading to a diagnosis of non-H. pylori gastritis and potentially increasing the risk of intestinal metaplasia, as seen in 2. Therefore, eradication of H. pyli should be prioritized in the management of gastritis to prevent long-term complications, especially in patients with chronic gastritis, as suggested by 4 and 5.
Management Approach
Given the potential for proton pump inhibitors to mask H. pylori infections and the importance of H. pylori eradication in preventing long-term complications, a thorough diagnostic workup including H. pylori testing should be performed before initiating long-term treatment with proton pump inhibitors, as recommended by 4. This approach ensures that patients receive appropriate treatment for their underlying condition, whether it be H. pylori eradication therapy or symptom relief with proton pump desenscers, to improve their morbidity, mortality, and quality of life.