Gastritis is a prevalent ailment, especially after taking some treatments which trigger inflammation in the stomach mucosa. Gastritis is just that. It features inflammation in the stomach and encompasses many conditions that induce swelling, which can be only found in a specific area of the stomach or the entire organ.
Gastritis can be divided into acute and chronic, depending on how long you have endured the symptoms. Acute gastritis has symptoms that are not serious enough to cause your health to be in jeopardy, but they can be very uncomfortable and reduce your quality of life. Chronic gastritis is a condition that affects your body for an extended period, which makes it more difficult to heal and has long-term consequences in some cases, such as stomach cancer when it is triggered by Helicobacter pylori infections.
Gastritis symptoms include nausea, vomiting, cramps, diarrhea, bloating, loss of appetite, and weight loss. If you experience any of these symptoms, it is best to visit your doctor immediately. The doctor will determine if you have acute or chronic gastritis and give you treatment for each. In this article, we’re going to talk about different treatment options for each.
1. Treatment of acute gastritis
Treatment basics of acute gastritis
Acute gastritis usually needs medical treatment as opposed to surgical procedures. The only case when surgical procedures are recommended is in case of acute necrotizing gastritis and phlegmonous gastritis, which are not the most common ailments.
In some cases, gastritis is associated with gastrointestinal tract bleeding, which manifests with hematemesis, melena, and a decrease in hemoglobin levels. In such cases, a stomach and duodenal ulcer should be ruled out, and doctors should investigate the possibility of stomach cancer.
Most instances of acute gastritis are quickly relieved with short-term over-the-counter drugs such as antacids and sucralfate, which work in mild and moderate cases. However, these patients should also keep in mind long-term changes in their habits and lifestyle, such as avoiding smoking and reducing caffeine intake and nonsteroidal anti-inflammatory drugs.
Medical care for acute gastritis
Different medications and treatment options exist for acute gastritis, but there is no specific therapy and treatment protocol, and medical care depends on the patient’s symptoms and underlying disease. The only specific therapy and medical care are for cases triggered by Helicobacter pylori infections.
A significant highlight of medical care for acute gastritis is the use of ranitidine, which was very popular until December 2019. During that time, the FDA announced that this drug should be recalled from the market because it was found to be contaminated with a carcinogenic molecule. The total withdrawal of ranitidine was made effective by April 2020. Since then, the number of medications available for acute gastritis has been reduced.
H. pylori eradication therapy in acute gastritis
As mentioned previous, one of the only treatment options standardized and made into a protocol for acute gastritis is Helicobacter pylori eradication. This treatment is usually made with a triple or quadruple therapy that includes bismuth, a proton-pump inhibitor, tetracycline, and nitroimidazole. Another option is using clarithromycin, amoxicillin, and a proton-pump inhibitor.
There are many variations of the same treatment. Sometimes your doctor can prescribe concomitant therapy with two antibiotics. In other cases, they can prescribe sequential treatment with one antibiotic for the first week and the other in the second week. There is even a type of hybrid therapy. However, they all last 10 to 14 days.
It is essential to highlight that the nitroimidazole molecule of choice is usually metronidazole. Tinidazole is not usually used to prevent drug resistance. Other antibiotics can be used, including levofloxacin.
Other treatment considerations
Gastritis treatment usually does not need to escalate and rarely requires hospitalization. But in some cases, fluids and electrolytes are necessary to correct an imbalance. This is particularly important when patients are vomiting very frequently.
It is also essential to detect the trigger of gastritis and discontinue using medications and lifestyle elements that may contribute to the disease. Patients taking low-dose aspirin should talk to their doctors to search for an alternative if they experience very frequent episodes of dyspepsia and gastritis symptoms.
Another important consideration with gastritis treatment is the interaction between proton pump inhibitors and the drug clopidogrel, which is antiplatelet therapy. With proton pump inhibitors, clopidogrel may decrease its activity and trigger heart problems. In such cases, pantoprazole is usually recommended because it has limited interaction with clopidogrel.
Acute gastritis prevention and monitoring
Some lifestyle factors and habits can be suggested to prevent future episodes of gastritis. First off, patients with known H. pylori infection should undergo eradication therapy as soon as possible. Secondly, the use of aspirin and nonsteroidal anti-inflammatory drugs should be limited to avoid gastroduodenal ulcers and stomach acid formation.
And even after Helicobacter pylori is apparently eradicated, patients should undergo long-term monitoring. It should start four weeks after completing their treatment with antibiotics and proton pump inhibitors. This eradication testing is performed with urease breath testing, but in some cases, a stool antigen test can also be used.
Checking for H. pylori eradication is particularly important in patients who still have symptoms after treatment, those with gastric cancer, and MALT lymphoma. But since it is a very simple procedure, it can also be done whenever patients require it.
Medications
We have mentioned above some of the most important medications to treat acute gastritis, which should include antibiotics in the case of Helicobacter pylori and always includes proton pump inhibitors. Other drugs used in these cases include:
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- Antacids: These are mainly used to prevent cases of gastritis and when mild symptoms start. They are sold over the counter and contain magnesium and aluminum to neutralize gastric acids.
- H2 Blockers: These histamine blockers suppress gastric acid output by acting on basal cells in the gastric mucosa. Ranitidine, which was mentioned above, was one of these. Other examples include cimetidine and famotidine.
- Antidiarrheal agents: One example of this is bismuth subsalicylate, which is used in association with antibiotics and proton pump inhibitors to treat H pylori.
2. Chronic gastritis treatment
• Basics of chronic gastritis treatment
There are different causes of chronic gastritis, but the most commonly known is Helicobacter pylori infection. This type of infection can trigger both acute and chronic gastritis symptoms. Another known cause of chronic gastritis is known as lymphocytic gastritis. However, once again, the only entity with an excellent background and treatment protocol is H pylori gastritis.
Other entities of chronic gastritis lack many studies, enough evidence, and well-established protocols to treat the disease. One suitable example is lymphocytic gastritis, which is known to improve with omeprazole, but some patients have experienced spontaneous healing.
Pharmacotherapy for H. pylori in chronic gastritis is similar to that of acute gastritis, as we will see below. However, in such cases, doctors should also consider the possibility of stomach cancer, especially in patients with a long history of symptoms.
• H. pylori treatment in chronic gastritis
There’s no easy cure for Helicobacter pylori infections, and that’s why all treatment protocols include multidrug therapy instead of one or two drugs. As mentioned with acute gastritis, multidrug treatment for H. pylori consists of an antimicrobial agent, which includes antibiotics that attack H pylori such as amoxicillin, clarithromycin, tetracycline, furazolidone, or metronidazole. These drugs should be used in combination because monotherapy almost invariably leads to antibiotic resistance.
The FDA currently approves five treatment regimes for H pylori in chronic gastritis. The traditional approach uses bismuth, metronidazole, and tetracycline. This treatment is sold under the name Helidac. Besides this conventional approach, three other combinations with clarithromycin are equally effective. However, in chronic gastritis, it is even more common that patients need a combination of regimes with bismuth-based therapy followed by clarithromycin-based treatment for complete eradication.
Treatment options for adults
Different triple therapies are available for adults in case of H pylori infections. For instance:
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- Lansoprazole (alternatively omeprazole or ranitidine bismuth citrate) plus clarithromycin plus amoxicillin (alternatively metronidazole). This combination has the benefit that all drugs are taken orally twice daily, and the administration is easy with pack kits containing triple therapy and making everything easy for patients.
- Lansoptrazole plus clarithromycin plus amoxicillin. This combination is considered the first-line treatment in many countries in Europe. It is also taken twice daily, and the success rate is very high.
- Bismuth subsalicylate plus metronidazole plus tetracycline hydrochloride. This is another combination that is contained in Helidac triple therapy packs. The downside is that it should be taken four times daily instead of two, which may reduce patient compliance.
Treatment options for children
The treatment of H pylori infection in children has not been studied enough and is not as clearly established as in adult patients. There is currently no consensus about which is the best treatment for children, and whether or not treating an active infection that remains asymptomatic is still controversial in the literature.
There are isolated studies using triple therapies in children that include metronidazole, clarithromycin, and a protein pump inhibitor. Another study used amoxicillin, clarithromycin, and lansoprazole for seven days with a very high eradication rate. Others have found a very low eradication rate in patients taking the same combination for two weeks. Thus, the evidence is still inconclusive, and the treatment remains controversial.
In children, we should also consider the high rate of adverse effects and bismuth subsalicylate toxicity, which should not be used in children younger than 16 years old because they can sometimes trigger Reye syndrome.
Long-term monitoring
Patients with chronic gastritis usually require endoscopy to find out the severity and extent of the damage. Depending on the initial finding, doctors may need a new endoscopy or another evaluation to see how well they went after treatment and whether they are safe from future complications, especially stomach cancer.
H pylori eradication should also be checked in these cases, and it is done four weeks after treatment. Noninvasive methods are preferred to check for H pylori eradication, which includes a urea breath test or a stool antigen test. The latter is more likely to be used because it is easier, and the results are available immediately.
» Conclusion
Treatment for acute and chronic gastritis is usually difficult in severe cases, especially when Helicobacter pylori infection is the leading cause of the symptoms. This entity does not only include H pylori infection, but this is the only entity that receives a particular treatment protocol. Other causes of acute and chronic gastritis are treated depending on the symptoms and the complications the patient experiences.
Medications such as proton pump inhibitors are one of the most important in treating the disease. Still, others, including H2 inhibitors and antacids, are mainly used in mild cases and in the prevention of gastritis.
Eradication of H pylori requires a combination of antibiotic treatments, proton pump inhibitors, and other drugs that may also be included, such as antidiarrheic agents and anti-parasitic medicines that are active against the bacteria.