What is the treatment for alcohol-induced gastritis?

Treatment of Alcohol-Induced Gastritis

The cornerstone of treating alcohol-induced gastritis is complete alcohol abstinence combined with proton pump inhibitors, nutritional support with 35-40 kcal/kg/day and protein 1.2-1.5 g/kg/day, and comprehensive vitamin supplementation, particularly B-complex vitamins. 1

Immediate Management

Alcohol Cessation

• Alcohol abstinence is the single most critical intervention, as continued drinking perpetuates mucosal damage and inflammation. 1
• Implement brief alcohol intervention during hospitalization using the FRAMES model: Feedback about dangers, Responsibility, Advice to abstain, Menu of alternatives, Empathy, and Self-efficacy encouragement. 1, 2
• Brief interventions reduce alcohol consumption by approximately 41 g/week. 3, 1
• Treat alcohol withdrawal syndrome with benzodiazepines as first-line therapy. 4, 2

Acid Suppression

• Prescribe proton pump inhibitors (PPIs) to reduce gastric acid secretion and promote mucosal healing. 1
• PPIs are more effective than H2-receptor antagonists, which are more effective than placebo for symptomatic relief. 3
• While thiamine absorption may be reduced in alcohol-related gastritis, thiamine can still be administered orally or enterally, though IV route is most efficient for acute deficiency. 3

Nutritional Therapy

Caloric and Protein Requirements

• Provide 35-40 kcal/kg/day with protein intake of 1.2-1.5 g/kg/day. 1, 4
• For severely ill patients, increase protein to 1.5 g/kg/day. 1

Essential Vitamin and Mineral Supplementation

• B-complex vitamins are especially critical in alcohol users and should be supplemented routinely. 1, 4
• Thiamine 100-300 mg/day IV should be administered without hesitation in patients with suspected reduced food intake or high alcohol consumption for 3-4 days. 3
• Additional supplementation should include vitamin A, vitamin B12, folic acid, pyridoxine, vitamin D, and zinc. 1

Management of Complications

Gastrointestinal Bleeding

• Endoscopic therapy is necessary for active bleeding related to alcoholic gastritis. 1
• Consider angiographic embolization when endoscopy is ineffective. 1

Nausea and Vomiting

• Use dopamine receptor antagonists (prochlorperazine, haloperidol, metoclopramide) as first-line agents. 1
• Add 5-HT3 receptor antagonists or anticholinergic agents for persistent symptoms. 1

Long-Term Management

Sustained Alcohol Abstinence

• Arrange extended alcohol counseling after discharge to maintain abstinence. 1, 4
• In alcohol-dependent patients without advanced liver disease, consider disulfiram, naltrexone, or acamprosate combined with counseling. 4
• Baclofen may be safe and effective for preventing relapse in patients with advanced alcoholic liver disease. 4

Psychosocial Support

• Individual psychotherapy should include psychiatric evaluation, psychoeducation, group therapy, and cognitive behavioral therapy. 4
• Involvement in Alcoholics Anonymous provides continued support after discharge. 4
• Family education and therapy benefit both patient and family members. 4

Critical Pitfalls to Avoid

• Monitor closely for nutritional deficiencies, which are common in alcoholic patients and worsen outcomes. 1
• Be vigilant for signs of alcohol withdrawal requiring specific management protocols. 1
• Recognize that alcoholic gastritis often coexists with alcoholic liver disease or pancreatitis, requiring additional management. 1
• Do not overlook Helicobacter pylori infection, which is common in alcoholics and may require antibiotic eradication therapy for symptomatic and histological improvement. 5