Acute Gastritis Treatment & Management

  • Author: Mohammad Wehbi, MD; Chief Editor: BS Anand, MD  more...
 
Updated: Feb 25, 2016
 

Approach Considerations

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.

Next

Medical Care

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.[6] 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.[10] 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]

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Contributor Information and Disclosures
Author

Mohammad Wehbi, MD Associate Professor of Medicine, Associate Program Director, Department of Gastroenterology, Emory University School of Medicine; Section Chief of Gastroenterology, Atlanta Veterans Affairs Medical Center

Mohammad Wehbi, MD is a member of the following medical societies: American College of Physicians, American Gastroenterological Association, American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Vincent W Yang, MD, PhD R Bruce Logue Professor, Director, Division of Digestive Diseases, Department of Medicine, Professor of Hematology and Oncology, Winship Cancer Institute, Emory University School of Medicine

Vincent W Yang, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, Association of American Physicians, American Gastroenterological Association, American Society for Clinical Investigation

Disclosure: Nothing to disclose.

Gwendolyn Sarver 

Disclosure: Nothing to disclose.

Kamil Obideen, MD Assistant Professor of Medicine, Division of Digestive Diseases, Emory University School of Medicine; Consulting Staff, Division of Gastrointestinal Endoscopy, Atlanta Veterans Affairs Medical Center

Kamil Obideen, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Sunil Dacha, MBBS, MD House Staff, Division of Digestive Disease, Emory University School of Medicine

Sunil Dacha, MBBS, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Additional Contributors

Waqar A Qureshi, MD Professor of Medicine, Chief of Endoscopy, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

Waqar A Qureshi, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Acknowledgements

Nicole M Griglione, MD Fellow in Gastroenterology, Department of Medicine, Emory University School of Medicine

Nicole M Griglione, MD is a member of the following medical societies: American Medical Association and Illinois State Medical Society

Disclosure: Nothing to disclose.

Richard H Snyder, MD Vice-Chair, Program Director, Department of Medicine, Norfolk General Hospital; Clinical Associate Professor, Department of Internal Medicine, East Virginia Medical School

Richard H Snyder, MD is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

References
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