What is the treatment approach for a patient with alcohol-induced gastritis?

Treatment of Alcohol-Induced Gastritis

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

Immediate Medical Management

Acid Suppression

• Initiate proton pump inhibitors (PPIs) as first-line therapy to reduce gastric acid secretion and promote mucosal healing 1
• PPIs are more effective than H2-receptor antagonists, which are superior to placebo for symptomatic relief 1
• Continue PPI therapy until mucosal healing is confirmed and symptoms resolve 2

Alcohol Cessation (Critical Priority)

• Mandate strict and complete alcohol abstinence - this is the single most important intervention, as continued alcohol consumption 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, Self-efficacy encouragement) 3
• Brief interventions reduce alcohol consumption by approximately 41 g/week 1, 4
• Arrange extended alcohol counseling after discharge to maintain long-term abstinence 1

Nutritional Therapy (Essential Component)

Caloric and Protein Requirements

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

Vitamin and Mineral Supplementation

• Administer B-complex vitamins (thiamine, vitamin B12, folic acid, pyridoxine) - these are especially critical in alcohol users due to common deficiencies 1
• Thiamine can be given orally/enterally at 100-300 mg/day, though IV route is most efficient for acute deficiency 1
• Supplement with vitamin A, vitamin D, and zinc 1

Management of Complications

Gastrointestinal Bleeding

• Perform endoscopic therapy 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 antiemetics 1
• Add 5-HT3 receptor antagonists or anticholinergic agents for persistent symptoms 1

Alcohol Withdrawal Management

• Monitor vigilantly for signs of alcohol withdrawal syndrome, which requires specific management protocols 1
• Benzodiazepines are the treatment of choice for alcohol withdrawal 3
• In alcohol-dependent patients without advanced liver disease, consider naltrexone or acamprosate combined with counseling to reduce relapse risk 2, 1

Helicobacter pylori Consideration

• Test for H. pylori infection, which is common in alcoholics and contributes to gastritis through ammonia production 5, 6
• Antibiotic eradication therapy results in histological and symptomatic improvement in H. pylori-positive patients with alcoholic gastritis 5, 6

Critical Pitfalls to Avoid

• Do not underestimate nutritional deficiencies - these are extremely common in alcoholic patients and worsen outcomes if left untreated 1
• Do not allow partial alcohol reduction - there is no safe amount of alcohol consumption after developing alcoholic gastritis; complete abstinence is mandatory 1
• Recognize coexisting conditions - alcoholic gastritis often occurs alongside alcoholic liver disease and pancreatitis, requiring additional management 1
• Do not use metoclopramide as monotherapy for GERD-like symptoms in these patients, as it has fair evidence of being ineffective 2

Long-Term Follow-Up

• Arrange individual psychotherapy including psychiatric evaluation, psychoeducation, group therapy, and cognitive behavioral therapy 3
• Encourage involvement in Alcoholics Anonymous or similar support groups for continued abstinence 3
• Provide family education and therapy, as social support is necessary for successful long-term outcomes 3
• Connect patients with community alcohol counseling centers for regular abstinence meetings 3