Approach to gastritis
Introduction
Gastritis is the acute or chronic inflammation of the gastric mucosa. The acute form is the most common stomach disorder. Gastritis may occur with other serious conditions, such as atrophy of the stomach.
Etiology and classification
Gastritis is usually caused by infectious agents (eg, Helicobacter pylori) or is immune mediated, although in many cases the cause of the gastritis is unknown.
Table (1). Causes of gastritis | |
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Comment | |
Acute gastritis |
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Chronic gastritis |
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Diagnosis
Diagnose gastric bleeding by performing a guaiac test, which may show positive for occult blood in vomitus or stools or both.
- Measure hemoglobin (Hb) level and hematocrit, which may be decreased. Conduct a urea breath test to identify H. pylori.
- Schedule an upper GI endoscopy within 24 hours of bleeding to detect inflammation of the gastric mucosa.
- Perform a biopsy to confirm the inflammatory process.
Management
Avoidance of mucosal irritants such as alcohol and NSAIDs. Lifestyle modifications with avoidance of tobacco and foods that trigger symptoms.
Pharmacologic therapy
Eradication of H. pylori, when present, can be accomplished with various regimens "see table 2". For further information, see note "Peptic ulcer; assessment and management". Prophylaxis and treatment of stress gastritis with sucralfate 1 g orally every 4 to 6hrs, H2-antagonists, or PPIs in patients on ventilator support. Chronic therapy, omeprazole, H2-antagonists, or sucralfate in patients receiving long-term NSAIDs. Avoidance of alcohol, tobacco, and prolonged NSAID or corticosteroid use.
Table (2). Management of H. pylori –associated acid peptic disease (14 DAY) | ||||
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Drug Class | Drug | Triple Therapy Dose | Quadruple Therapy Dose | Sequential Therapy Dose |
Acid suppression | Proton pump inhibitor (PPI) | 20-40 mg BID | 20-40 mg BID | 20-40 mg BID |
Standard antimicrobials | Bismuth compound | 2 tablets BID | 2 tablets BID | |
Amoxicillin | 1 g BID | 1 g BID | ||
Metronidazole | 500 mg BID | 500 mg TID | 500 mg BID | |
Clarithromycin | 500 mg BID | 500 mg BID | ||
Tetracycline | 500 mg QID | |||
Salvage antimicrobials | Levofloxacin | 300 mg BID | 300 mg BID | |
Doxycycline | 100 mg BID | |||
Nitazoxanide | 1 g BID | |||
PPI = proton pump inhibitor, BID = Twice daily, QID = 4 times daily, TID = 3 times daily |
References
- Acute Gastritis Treatment & Management: Approach Considerations, Medical Care, Prevention. (2020). eMedicine. [online] Available at: https://emedicine.medscape.com/article/175909-treatment.
- Chronic Gastritis Treatment & Management: Approach Considerations, Pharmacotherapy for H pylori, Long-Term Monitoring. (2019). eMedicine. [online] Available at: https://emedicine.medscape.com/article/176156-treatment.
- Jensen PJ. Gastritis: Etiology and diagnosis. UpToDate 2024. [online] Available at: https://www.uptodate.com/contents/gastritis-etiology-and-diagnosis.