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
Comment
Acute gastritis
  • Chronic ingestion of irritating foods and alcohol
  • Complication of acute illness
  • Drugs such as aspirin and other nonsteroidal anti-inflammatory agents (in large doses), cytotoxic agents, caffeine, corticosteroids, antimetabolites, and indomethacin
  • Endotoxins released from infecting bacteria, such as staphylococci, Escherichia coli, and salmonella
  • Ingested poisons, especially dichlorodiphenyltrichloroethane, ammonia, mercury, carbon tetrachloride, or corrosive substances
Chronic gastritis
  • Helicobacter pylori infection (common in nonerosive gastritis)
  • Pernicious anemia, renal disease, or diabetes mellitus
  • Recurring exposure to irritating substances, such as drugs, alcohol, cigarette smoke, and environmental agents

NPS-adv

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)
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

NPS-adv


References

  1. Acute Gastritis Treatment & Management: Approach Considerations, Medical Care, Prevention. (2020). eMedicine. [online] Available at: https://emedicine.medscape.com/article/175909-treatment.
  2. 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.
  3. Jensen PJ. Gastritis: Etiology and diagnosis. UpToDate 2024. [online] Available at: https://www.uptodate.com/contents/gastritis-etiology-and-diagnosis.