What is the treatment for viral gastritis?

Treatment of Viral Gastritis

The primary treatment for viral gastritis is oral rehydration therapy (ORT) to prevent dehydration, as the condition is self-limited and resolves within days without specific antiviral therapy. 1

Core Treatment Principles

Oral rehydration therapy is the cornerstone of management and should be the first-line approach for all patients with viral gastritis, as it is as effective as intravenous therapy for mild-to-moderate dehydration. 1 The main therapeutic goal is preventing and correcting dehydration and electrolyte imbalances, which pose the primary risk rather than the viral infection itself. 1

When to Use Intravenous Fluids

Reserve hospitalization and intravenous rehydration only for:

• Severe dehydration that cannot be corrected orally 1
• Failed oral rehydration attempts after appropriate trials 2
• Signs of severe dehydration including decreased urine output, dry mouth and tongue, sunken eyes, no tears when crying (children), or unusual drowsiness 1

Antiemetic Therapy for Refractory Vomiting

For patients with significant vomiting that limits oral rehydration, ondansetron is the most effective antiemetic and should be considered as first-line therapy. 2, 3

• Ondansetron dosing: 0.15 mg/kg IV (or single oral dose) for children over 4 years and adolescents 1, 2
• Ondansetron reduces hospital admission rates from 20.5% to 4.4% compared to IV fluids alone 2
• Ondansetron improves oral fluid tolerance at 2 hours (86.6% vs 67.4% with IV fluids alone) 2
• Dexamethasone (1 mg/kg IV, max 15 mg) showed no significant benefit over placebo 2

Symptomatic Management

Antidiarrheal Medications

• Avoid antimotility drugs (loperamide) in children under 18 years 1
• Loperamide may be considered in immunocompetent adults with acute watery diarrhea, but avoid in inflammatory diarrhea or fever 1
• Bismuth subsalicylate may provide modest symptomatic relief, reducing illness duration by approximately 7 hours 1

Nutritional Management

• Continue feeding throughout illness - early refeeding decreases intestinal permeability, reduces illness duration, and improves nutritional outcomes 1
• Breast milk has protective effects and infants can be "fed through" episodes 1
• Mild lactose intolerance may occur for 10-14 days post-rotavirus infection; a lactose-free diet reduces diarrhea duration by 18 hours in children under 5 years 1

Special Population Considerations

High-Risk Groups Requiring Close Monitoring

• Children: Highest risk for dehydration but respond well to ORT 1
• Elderly patients on diuretics: Require special attention to hydration status due to increased dehydration risk 1
• Pregnant women: No specific threat beyond dehydration risks; viremic states do not occur, so transplacental exposure risk is minimal 1

Infection Control Measures

To prevent transmission:

• Vigorous handwashing with soap is essential 1
• Exclude symptomatic staff from patient contact for at least 2 days after symptom resolution 1
• Clean environmental surfaces, especially areas soiled by feces or vomitus 1
• Separate ill persons from well persons until 2 days after symptom resolution 1

When Specific Antiviral Therapy Is Indicated

For immunocompromised patients (particularly hematology/oncology patients) with CMV gastroenteritis, specific antiviral treatment is required:

• Ganciclovir 5 mg/kg IV twice daily for 2-3 weeks (induction), followed by maintenance therapy at 5 mg/kg IV daily on 5-6 days per week for several weeks 4
• Diagnosis requires CMV detection in endoscopic biopsy specimens from affected gastrointestinal mucosa, not just peripheral blood or stool 4
• Alternative agents include foscarnet or cidofovir, though both carry significant renal toxicity 4

Critical Pitfalls to Avoid

• Do not delay ORT waiting for laboratory results - begin rehydration immediately based on clinical assessment 1
• Do not routinely use antiemetics in all cases - reserve for significant vomiting that impairs oral rehydration 1, 2
• Do not assume viral etiology if bloody diarrhea is present - this is atypical and requires investigation for bacterial or other causes 5
• Do not use rectal swabs for viral diagnosis - they have little to no diagnostic value 4