From the Guidelines
Viral gastritis caused by norovirus is typically a self-limiting illness that resolves within 1-3 days in otherwise healthy individuals, and treatment should focus on supportive care to manage symptoms and prevent dehydration. The primary goal is to maintain hydration and manage symptoms until the infection resolves naturally, typically within 3-7 days 1. Patients should drink clear fluids like water, diluted sports drinks, or oral rehydration solutions (such as Pedialyte) in small, frequent amounts to prevent dehydration.
Symptom Management
For symptom management, acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) can help with fever and discomfort. Anti-nausea medications like ondansetron (4-8mg every 8 hours as needed) may be prescribed for severe vomiting. Patients should follow a bland diet, starting with easily digestible foods like crackers, toast, rice, and bananas once vomiting subsides.
Prevention and Control
Prevention involves thorough handwashing, especially after using the bathroom and before handling food, as these viruses spread through the fecal-oral route 1. In institutional settings, excluding ill staff and isolating ill residents can help prevent the spread of the virus. Environmental surfaces should be disinfected using a chlorine bleach solution or other EPA-approved disinfectant.
When to Seek Medical Attention
Most cases resolve without complications, but medical attention should be sought if symptoms include severe abdominal pain, bloody vomit or stool, signs of dehydration (decreased urination, extreme thirst, dizziness), or if symptoms persist beyond a week. It is essential to note that norovirus-associated deaths have been reported among elderly persons and in the context of outbreaks in long-term–care facilities 1. Therefore, prompt medical attention is crucial for high-risk individuals or those with severe symptoms.
From the Research
Viral Gastritis Treatment
- The study 2 compared the efficacy of intravenous ondansetron or dexamethasone with intravenous fluid therapy alone in children with refractory vomiting from viral gastritis.
- The results showed that ondansetron with intravenous rehydration improves tolerance of oral fluids after two hours and reduces the hospital admission rate when compared with intravenous rehydration with or without dexamethasone.
- Another study 3 discussed the diagnosis and management of acute gastroenteritis in the emergency department, highlighting that most cases are of viral etiology and require only supportive care.
Risk Factors for Viral Gastritis
- A study 4 found that therapy with gastric acidity inhibitors increases the risk of acute gastroenteritis and community-acquired pneumonia in children.
- The study suggested that the use of gastric acidity inhibitors was associated with an increased risk of acute gastroenteritis and community-acquired pneumonia in GERD-affected children.
Treatment of Gastroesophageal Reflux Disease (GERD)
- A review 5 evaluated the role of combination therapy with proton-pump inhibitors (PPIs) and histamine(2) receptor antagonists in GERD, finding that no studies demonstrate that the addition of histamine(2) receptor antagonists to twice-daily PPI therapy provides any further benefit above that derived from PPIs alone.
- Another study 6 compared the healing and relapse rates in GERD treated with newer PPIs (lansoprazole, rabeprazole, and pantoprazole) compared with omeprazole, ranitidine, and placebo, finding that all PPIs were superior to ranitidine and placebo in healing erosive esophagitis and decreasing relapse rates.