Sections

Stress-Induced Gastritis

Medication

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

Proton-pump inhibitors (PPIs) have not been fully evaluated in the role of prophylaxis for this disease.

Class Summary

Shown to be effective in the prevention of stress-induced gastritis.

Sucralfate (Carafate)

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Binds with positively charged proteins in exudates and forms a viscous adhesive substance that protects the GI lining against pepsin, peptic acid, and bile salts. Primary agent for prophylaxis of stress gastritis.

Class Summary

These agents block H2 receptor binding. The primary indication is to reduce symptoms and to accelerate healing of gastric ulcers. In the acutely bleeding patient, they are of limited benefit. Some have also been used for prophylaxis (eg, famotidine).

Famotidine (Pepcid)

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Competitively inhibits histamine at H2 receptor of gastric parietal cells, resulting in reduced gastric acid secretion, gastric volume, and hydrogen ion concentrations.

Nizatidine (Axid)

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Competitively inhibits histamine at H2 receptors of gastric parietal cells, resulting in reduced gastric acid secretion, gastric volume, and reduced hydrogen concentrations.

Cimetidine (Tagamet)

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Inhibits histamine at H2 receptors of gastric parietal cells, which results in reduced gastric acid secretion, gastric volume, and hydrogen concentrations.

Ranitidine (Zantac)

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Inhibits histamine stimulation of the H2 receptor in gastric parietal cells, which, in turn, reduces gastric acid secretion, gastric volume, and hydrogen ion concentrations.

Class Summary

Proton pump inhibitors are inhibitors of the gastric H⁺/K⁺ -ATPase (proton pump) enzyme system, which catalyzes the exchange of H⁺ and K⁺.

Esomeprazole (Nexium)

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S-isomer of omeprazole. Inhibits gastric acid secretion by inhibiting H⁺/K⁺ -ATPase enzyme system at secretory surface of gastric parietal cells.

Used in severe cases and in patients not responding to H2 antagonist therapy.

Used for up to 4 weeks to treat and relieve symptoms of active duodenal ulcers; may be used for up to 8 weeks to treat all grades of erosive esophagitis.

Pantoprazole (Protonix)

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Pantoprazole suppresses gastric acid secretion by specifically inhibiting the H+/K+-ATPase enzyme system at the secretory surface of gastric parietal cells. Use of the intravenous preparation has only been studied for short-term use (ie, 7-10 days).

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Author

Rohan C Clarke, MD Attending Physician, Department of Gastroenterology, JPS Health Systems Hospital

Rohan C Clarke, MD is a member of the following medical societies: American College of Gastroenterology, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Coauthor(s)

Rachael M Ferraro, DO Internal Medicine Hospitalist, Torrance Memorial Medical Center, Little Company of Mary Hospital

Rachael M Ferraro, DO is a member of the following medical societies: American College of Osteopathic Internists, American College of Physicians, American Osteopathic Association

Disclosure: Nothing to disclose.

Emmanuel Gbadehan, MD Instructor in Clinical Medicine, Columbia University College of Physicians and Surgeons; Consulting Staff, Department of Gastroenterology, Harlem Hospital Center, North General Hospital

Emmanuel Gbadehan, MD is a member of the following medical societies: American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Uzodinma R Dim, MD Clinical Cardiac Electrophysiology Fellow, Division of Cardiovascular Medicine, University of Iowa Hospital and Clinics

Uzodinma R Dim, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, Association of Black Cardiologists

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.

Acknowledgements

Simmy Bank, MD Chair, Professor, Department of Internal Medicine, Division of Gastroenterology, Long Island Jewish Hospital, Albert Einstein College of Medicine

Disclosure: Nothing to disclose.

Stress-Induced Gastritis Medication

Medication Summary

Gastrointestinal agents