Duration of PPI Treatment for Gastritis
For H. pylori-Positive Gastritis
PPI therapy should be administered for exactly 14 days as part of the eradication regimen, and then discontinued after confirming successful eradication—there is no role for continued PPI monotherapy in H. pylori gastritis. 1, 2
Standard Treatment Duration
The recommended duration is 14 days for all first-line H. pylori eradication regimens, whether using bismuth quadruple therapy or concomitant non-bismuth quadruple therapy. 1, 2
Extending treatment from 7 to 14 days improves eradication success by approximately 5%, making the 14-day duration mandatory for optimal outcomes. 1, 2
PPI should be dosed twice daily (not once daily) throughout the entire 14-day treatment period, taken 30 minutes before meals on an empty stomach. 2, 3
After Eradication Treatment
PPI therapy should be stopped after completing the 14-day eradication regimen in uncomplicated cases. 1
Confirm eradication with urea breath test or monoclonal stool antigen test at least 4 weeks after completion of therapy and at least 2 weeks after PPI discontinuation. 1, 3
Prolonged PPI therapy beyond eradication is NOT recommended for uncomplicated H. pylori gastritis, as successful eradication cures the gastritis and eliminates the need for acid suppression. 1
Special Circumstances Requiring Extended PPI
In gastric ulcer cases: Continue PPI after eradication treatment until complete ulcer healing is confirmed endoscopically, as gastric ulcers require longer acid suppression than duodenal ulcers. 1
In complicated duodenal ulcer: Continue PPI treatment after eradication until H. pylori eradication is confirmed. 1
In bleeding peptic ulcer: Start H. pylori eradication immediately when oral feeding is reintroduced, and continue PPI until eradication is confirmed. 1, 3
For H. pylori-Negative Gastritis
The duration of PPI therapy for H. pylori-negative gastritis depends on the underlying cause and symptom resolution, but long-term PPI use should be minimized due to potential adverse effects on gastric mucosa. 4, 5, 6
Important Considerations for Long-Term PPI Use
Chronic PPI use in the presence of undiagnosed H. pylori infection promotes corpus-predominant pangastritis and accelerates the development of atrophic gastritis, which is associated with increased gastric cancer risk. 5, 6, 7
Long-term PPI therapy (beyond 1 year) can mask H. pylori infection, leading to false-negative testing and increased risk of intestinal metaplasia. 4, 8
Before initiating long-term PPI therapy (>8 weeks), H. pylori testing and eradication should be performed to prevent progression of corpus atrophic gastritis. 5, 7
Critical Pitfalls to Avoid
Never continue PPI monotherapy indefinitely for H. pylori-positive gastritis without eradicating the infection, as this worsens corpus gastritis and promotes atrophic changes. 5, 6, 7
Do not use standard-dose PPI once daily during eradication therapy—twice-daily high-dose PPI is mandatory for optimal eradication rates. 1, 2, 3
Avoid testing for H. pylori eradication while still taking PPIs, as this leads to false-negative results; discontinue PPI at least 2 weeks before testing. 1, 3
In patients requiring long-term PPI for GERD, test and treat H. pylori when maintenance therapy is prescribed, not necessarily before starting short-term PPI therapy. 5