Acute Gastritis Treatment & Management
- Author: Mohammad Wehbi, MD; Chief Editor: BS Anand, MD more...
Surgical intervention is not necessary, except in the case of phlegmonous gastritis. With this entity, surgical intervention with resection of the affected area may be the most effective form of treatment.
Consult a gastroenterologist in complicated cases.
Administer medical therapy as needed, depending on the cause and the pathological findings.
No specific therapy exists for acute gastritis, except for cases caused by H pylori. The American College of Gastroenterology guidelines suggest that the current evidence does not support the notion that treating H pylori worsens gastroesophageal reflux disease (GERD). For patients who need eradication of H pylori, this should not be a concern. In patients with persistent H pylori infection despite appropriate initial treatment, combination therapy with a a proton pump inhibitor (PPI), levofloxacin, and amoxicillin for 10 days appears to be more effective and better tolerated than a PPI, bismuth, tetracycline, and metronidazole. However this has not been validated in the US literature.[6, 7, 8, 9]
Administer fluids and electrolytes as required, particularly if the patient is vomiting.
Discontinue the use of drugs known to cause gastritis (eg, NSAIDs, alcohol). A long-term prospective study found that patients with arthritis who were older than 65 years and regularly took low-dose aspirin were at an increased risk for dyspepsia severe enough to necessitate the discontinuation of NSAIDs. This suggests that better management of NSAID use should be discussed with older patients in order to reduce NSAID-associated upper GI events.
There has been a growing concern in recent years regarding the interaction between PPIs and clopidogrel. A decrease in the antiplatelet activity of clopidogrel with a possible increase in adverse cardiac events is postulated. Pharmacokinetically it has been shown that omeprazole and lansoprazole interact significantly with clopidogrel, and that omeprazole, rabeprazole, and esomeprazole interact with prasugrel. Pantoprazole has been shown to have the least interaction and thus, pantoprazole with low CYP2C19-inhibiting properties appears to be the safest PPI to be used with clopidogrel until more concrete evidence is available.[6, 11]
Sonnenberg A, Genta RM. Inverse association between Helicobacter pylori gastritis and microscopic colitis. Inflamm Bowel Dis. 2016 Jan. 22(1):182-6. [Medline].
Jensen ET, Martin CF, Kappelman MD, Dellon ES. Prevalence of eosinophilic gastritis, gastroenteritis, and colitis: estimates from a national administrative database. J Pediatr Gastroenterol Nutr. 2016 Jan. 62(1):36-42. [Medline].
Biecker E. Diagnosis and therapy of non-variceal upper gastrointestinal bleeding. World J Gastrointest Pharmacol Ther. 2015 Nov 6. 6(4):172-82. [Medline].
Gisbert JP, Gisbert JL, Marcos S, Moreno-Otero R, Pajares JM. Third-line rescue therapy with levofloxacin is more effective than rifabutin rescue regimen after two Helicobacter pylori treatment failures. Aliment Pharmacol Ther. 2006 Nov 15. 24(10):1469-74. [Medline].
Ford AC, Marwaha A, Lim A, Moayyedi P. What is the prevalence of clinically significant endoscopic findings in subjects with dyspepsia? Systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2010 Oct. 8(10):830-7, 837.e1-2. [Medline].
Drepper MD, Spahr L, Frossard JL. Clopidogrel and proton pump inhibitors--where do we stand in 2012?. World J Gastroenterol. 2012 May 14. 18(18):2161-71. [Medline].
Chey WD, Wong BC. American College of Gastroenterology guideline on the management of Helicobacter pylori infection. Am J Gastroenterol. 2007 Aug. 102(8):1808-25. [Medline].
Saad RJ, Schoenfeld P, Kim HM, Chey WD. Levofloxacin-based triple therapy versus bismuth-based quadruple therapy for persistent Helicobacter pylori infection: a meta-analysis. Am J Gastroenterol. 2006 Mar. 101(3):488-96. [Medline].
Gisbert JP, Morena F. Systematic review and meta-analysis: levofloxacin-based rescue regimens after Helicobacter pylori treatment failure. Aliment Pharmacol Ther. 2006 Jan 1. 23(1):35-44. [Medline].
Laine L, Curtis SP, Cryer B, Kaur A, Cannon CP. Risk factors for NSAID-associated upper GI clinical events in a long-term prospective study of 34 701 arthritis patients. Aliment Pharmacol Ther. 2010 Nov. 32(10):1240-8. [Medline].
Chen CH, Yang JC, Uang YS, Lin CJ. Differential inhibitory effects of proton pump inhibitors on the metabolism and antiplatelet activities of clopidogrel and prasugrel. Biopharm Drug Dispos. 2012 Jul. 33(5):278-83. [Medline].
Andersen LP. Colonization and infection by Helicobacter pylori in humans. Helicobacter. 2007 Nov. 12 Suppl 2:12-5. [Medline].
Beers M, Berkow R, eds. Gastritis. The Merck Manual of Diagnosis and Therapy. 18th ed. 2006. Section 3, Chapter 23. [Full Text].
Feldman. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 7th ed. 2002. 810-823.
Ford A, Delaney B, Forman D. Eradication therapy for peptic ulcer disease in Helicobacter pylori positive patients. Cochrane Database Syst Rev. 2004. CD003840.
Gelfand DW, Ott DJ, Chen MY. Radiologic evaluation of gastritis and duodenitis. AJR Am J Roentgenol. 1999 Aug. 173(2):357-61. [Medline].
Gisbert JP, Pajares JM. Diagnosis of Helicobacter pylori infection by stool antigen determination: a systematic review. Am J Gastroenterol. 2001 Oct. 96(10):2829-38. [Medline].
Haruma K. Helicobacter heilmannii: a spiral shaped organism other than Helicobacter pylori. Intern Med. 1999 Mar. 38(3):217-8. [Medline].
Ikenberry SO, Harrison ME, Lichtenstein D, et al. The role of endoscopy in dyspepsia. Gastrointest Endosc. 2007 Dec. 66(6):1071-5. [Medline].
Iwakiri Y, Kabemura T, Yasuda D, et al. A case of acute phlegmonous gastritis successfully treated with antibiotics. J Clin Gastroenterol. 1999 Mar. 28(2):175-7. [Medline].
Kasper DL, Braunwald E, Fauci A, et al. Gastritis. Harrison's Principles of Internal Medicine: Companion Handbook. 16th ed. McGraw-Hill: 2006. Part 12, Chapter 274.
Richieri JP, Pol B, Payan MJ. Acute necrotizing ischemic gastritis: clinical, endoscopic and histopathologic aspects. Gastrointest Endosc. 1998 Aug. 48(2):210-2. [Medline].
Soltermann A, Koetzer S, Eigenmann F, et al. Correlation of Helicobacter pylori virulence genotypes vacA and cagA with histological parameters of gastritis and patient's age. Mod Pathol. 2007 Aug. 20(8):878-83. [Medline]. [Full Text].
Srivastava A, Lauwers GY. Pathology of non-infective gastritis. Histopathology. 2007 Jan. 50(1):15-29. [Medline].
Suerbaum S, Michetti P. Helicobacter pylori infection. N Engl J Med. 2002 Oct 10. 347(15):1175-86. [Medline].
Yamamoto T, Matsumoto J, Shiota K, et al. Helicobacter heilmannii associated erosive gastritis. Intern Med. 1999 Mar. 38(3):240-3. [Medline].
Morimoto M, Tamura S, Hayakawa T, et al. Phlegmonous gastritis associated with group A streptococcal toxic shock syndrome. Intern Med. 2014. 53 (22):2639-42. [Medline].
Min SY, Kim YH, Park WS. Acute phlegmonous gastritis complicated by delayed perforation. World J Gastroenterol. 2014 Mar 28. 20 (12):3383-7. [Medline].
Sugano K, Tack J, Kuipers EJ, et al, for the faculty members of Kyoto Global Consensus Conference. Kyoto global consensus report on Helicobacter pylori gastritis. Gut. 2015 Sep. 64 (9):1353-67. [Medline].
Shadifar M, Ataee R, Ataie A, et al. Genetic and molecular aspects of Helicobacter pylori in gastritis, pre- cancerous conditions and gastric adenocrcinoma. Gastroenterol Hepatol Bed Bench. 2015 Spring. 8(Suppl 1):S15-22. [Medline].