Is Maalox Effective for Gastritis?
Antacids like Maalox provide only rapid, temporary symptom relief for gastritis but do not heal the underlying inflammation or address the root cause—they are not recommended as primary treatment and should be reserved for on-demand breakthrough symptoms only. 1, 2
Why Antacids Are Not First-Line Treatment
Proton pump inhibitors (PPIs) have replaced antacids as the standard of care for gastritis because they are far more effective at healing gastric mucosal inflammation. 3 The American College of Gastroenterology specifically recommends high-potency PPIs such as esomeprazole 20-40 mg twice daily or rabeprazole 20 mg twice daily as first-line treatment, taken 30 minutes before meals for at least 8 weeks. 4, 1, 2
Antacids only neutralize existing stomach acid temporarily—they do not reduce acid production or promote mucosal healing like PPIs do. 3 While antacids can provide quick relief of heartburn or epigastric pain within minutes, this effect lasts only 30-60 minutes and does nothing to heal erosive changes or address inflammation. 5, 1
Limited Role: Adjunctive Use Only
The only appropriate use for antacids in gastritis management is as adjunctive therapy for breakthrough symptoms while on PPI treatment. 5, 1 For example, alginate-containing antacids may help with post-prandial symptoms by neutralizing the acid pocket that forms after meals. 5
Critical Treatment Priorities You Cannot Miss
1. Test for H. pylori Infection
All patients with gastritis must be tested for H. pylori using urea breath test or stool antigen test—never rely on serology. 4, 1 If positive, bismuth quadruple therapy for 14 days (PPI + bismuth + metronidazole + tetracycline) is mandatory, as H. pylori eradication is the only way to achieve long-term healing and prevent progression to atrophic gastritis and gastric cancer. 4, 1, 2
2. Discontinue NSAIDs Immediately
If gastritis is NSAID-induced, stop all NSAIDs immediately if clinically feasible. 1 If NSAIDs cannot be stopped, high-dose PPI therapy must be continued indefinitely for gastroprotection—antacids are completely inadequate for this purpose. 1
3. Use Appropriate PPI Dosing
Inadequate PPI dosing is a common pitfall. 4, 1 PPIs must be taken 30 minutes before meals, not with food or at bedtime, to maximize effectiveness. 4, 2 Treatment duration must be at least 8 weeks to allow mucosal healing—premature discontinuation prevents adequate recovery. 4, 1
Why Historical Data on Antacids Is Misleading
Older studies from the 1980s-1990s showed antacids had some efficacy for stress gastritis in ICU patients 6, 7, but this was before PPIs became available. Current evidence clearly demonstrates PPIs are superior to antacids for all forms of gastritis. 3 The development of H2-receptor antagonists and PPIs has "significantly reduced usage [of antacids] for duodenal and gastric ulcers and gastro-oesophageal reflux disease." 3
Common Pitfalls to Avoid
- Relying on antacids as primary treatment delays proper diagnosis and allows progression of gastritis to atrophy or ulceration 4, 1
- Failing to test for H. pylori when present leads to persistent inflammation and cancer risk 4, 1
- Using symptom relief as the endpoint without confirming H. pylori eradication or mucosal healing allows persistent infection 4, 1
- Inadequate PPI timing or dosing (not taking 30 minutes before meals) reduces effectiveness by 50% or more 4, 2
The Bottom Line
Start high-potency PPI therapy immediately (esomeprazole 20-40 mg or rabeprazole 20 mg twice daily, 30 minutes before meals), test for H. pylori, and reserve antacids only for occasional breakthrough symptoms. 4, 1, 2 Antacids alone will not heal gastritis and may give false reassurance while the underlying disease progresses.