Acute Gastritis Treatment & Management

Updated: Jun 13, 2019
  • Author: Mohammad Wehbi, MD; Chief Editor: BS Anand, MD  more...
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Treatment

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.

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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. [7] In patients with persistent H pylori infection despite appropriate initial treatment, combination therapy with a proton pump inhibitor (PPI), levofloxacin, and amoxicillin for 10 days appears to be more effective and better tolerated than a combination of a PPI, bismuth, tetracycline, and metronidazole. However this has not been validated in the US literature. [7, 8, 9, 10]

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. [11] 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. [7, 12]

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Long-Term Monitoring

H pylori eradication testing can be performed 4 weeks after completing therapy. It is carried out using either the rapid urease breath testing or stool antigen testing. However, it is not cost effective and is not always done. The current recommendation is that patients with ulcers from H pylori, MALT lymphoma, history of gastric cancer, and those with no improvement of symptoms despite treatment must be checked for resolution of H pylori infection. [7]

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