Treatment of Gastritis

Treatment consist of stopping identifiable causes such as NSAID's or alcohol, reducing acid production with proton pump inhibitors (PPI) and eliminating H pylori with antibiotics if suspected or identified.

Antacids
Used for general prophylaxis. Antacids containing aluminum and magnesium can help relieve symptoms of gastritis by neutralizing gastric acids. These agents are inexpensive and safe.

Aluminum and magnesium hydroxide, magnesia and alumina oral suspension (Rulox)
Drug combination that neutralizes gastric acidity and increases pH of the stomach and duodenal bulb. Aluminum ions inhibit smooth-muscle contraction and inhibit gastric emptying. Magnesium/aluminum antacid mixtures are used to avoid bowel function changes.
Adult
5-15 mL PO; 650 mg to 1.3 g tab PO qid
Pediatric
0.5 mL/kg PO qid prior to eating

H2 blockers
This class includes drugs whose mechanism of action is competitive inhibition of histamine at the histamine 2 (H2) receptor. Histamine plays an important role in gastric acid secretion, thereby making H2 blockers effective suppressors of basal gastric acid output and acid output stimulated by food and the neurological system. When used alone, they are frequently used as antisecretory drugs in H pylori therapy regimens. There are different drugs with different potencies and half-lives (eg, cimetidine, ranitidine, famotidine, nizatidine). Cimetidine will be discussed below as a representative of this class of drugs.

Cimetidine (Tagamet)
Inhibits histamine at H2 receptors of gastric parietal cells, which results in reduced gastric acid secretion, gastric volume, and hydrogen concentrations.
Adult
150 mg PO qid; not to exceed 600 mg/d
50 mg/dose IV/IM q6-8h; not to exceed 400 mg/d
Pediatric
Not established
Proton pump inhibitors
Proton pump inhibitors are potent inhibitors of the proton (acid) pump (ie, the enzyme H+,K+-ATPase), located in the apical secretory membrane of the gastric acid secretory cells (parietal cell). Proton pump inhibitors can completely inhibit acid secretion and have a long duration of action. They are the most effective gastric acid blockers. Omeprazole will be discussed as a representative of this class of drugs.

Omeprazole (Prilosec)
Decreases gastric acid secretion by inhibiting the parietal cell H+/K+-ATPase pump.
Adult
20 mg PO bid
Pediatric
Not established

H pylori Infections

Recommended therapy for H pylori infections consists of two or three antibiotics with a proton pump inhibitor.

Triple therapy

Clarithromycin (Biaxin): 500 mg PO bid with Amoxicillin (Amoxil): 1 g PO bid or Metronidazole (Flagyl) 500mg PO bid
And
Omeprazole (Prilosec): 20 mg PO bid or
Lansoprazole (Prevacid): 30 mg PO bid or
Rabeprazole (Aciphex): 20 mg PO bid or
Esomeprazole (Nexium): 40 mg PO qd

Quadruple therapy

Bismuth 525 mg PO qid and Metronidazole 500 mg PO qid and  Tetracycline 500 mg PO qid
with
Omeprazole (Prilosec): 20 mg PO bid or
Lansoprazole (Prevacid): 30 mg PO bid or
Rabeprazole (Aciphex): 20 mg PO bid or
Esomeprazole (Nexium): 40 mg PO qd

Quadruple therapy is usually reserved for patients who have failed one course of treatment

Surgery may be required for perforation, obstruction, uncontrolled or recurrent bleeding and symptoms that do not respond to drug therapy.