Approach to gastritis

Introduction ㅡ 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.

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

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 (table 2). For further information, see note on 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

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

  Ferri, F.F. (2020). Ferri’s clinical advisor 2020 : 5 books in 1. Philadelphia, Pa: Elsevier. Uptodate.com. (2019). UpToDate. [online] Available at: https://www.uptodate.com/contents/gastritis-etiology-and-diagnosis