From the Research
The first-line intravenous treatment for patients with gastralgia (stomach pain) typically includes proton pump inhibitors (PPIs) such as pantoprazole 40 mg IV once daily or esomeprazole 40 mg IV once daily, as supported by the most recent study 1. These medications reduce gastric acid production, providing relief from pain caused by acid-related conditions like gastritis, peptic ulcer disease, or gastroesophageal reflux. For patients with severe pain, adding an IV analgesic such as paracetamol (acetaminophen) 1000 mg every 6 hours may be appropriate. Antiemetics like ondansetron 4-8 mg IV every 8 hours can be administered if nausea or vomiting accompanies the gastralgia. IV fluid hydration should be maintained with normal saline or Ringer's lactate solution. Treatment duration typically ranges from 24-72 hours, after which patients should transition to oral medications once they can tolerate them. PPIs work by irreversibly inhibiting the hydrogen-potassium ATPase enzyme system in gastric parietal cells, effectively reducing acid secretion by up to 90%, which allows the gastric mucosa to heal and reduces pain, as described in earlier studies 2, 3, 4, 5. It's essential to investigate the underlying cause of gastralgia while providing symptomatic relief, as treatment may need adjustment based on the specific diagnosis. The most recent study 1 suggests that Helicobacter pylori cure can be achieved without PPIs as first-line treatment in about 90% of patients with corpus atrophic gastritis, but this does not directly apply to the general treatment of gastralgia. Therefore, the use of PPIs like pantoprazole or esomeprazole remains a standard approach for initial management. Key points to consider in treatment include:
- The use of PPIs as first-line therapy for gastralgia
- Addition of analgesics or antiemetics as needed
- Maintenance of IV fluid hydration
- Transition to oral medications after 24-72 hours
- Investigation into the underlying cause of gastralgia to adjust treatment as necessary.