Gastritis management

Gastritis management

Gastritis is an inflammatory mucosal response to injury from a variety of agents and mechanisms, including infections, drugs, alcohol, acute stress, radiation, allergy, acid and bile, ischaemia, or direct trauma.

The inflammation may involve the entire stomach (pangastritis) or a specific region of the stomach (antral gastritis). The severity of inflammation may be erosive or non-erosive.

Clinical presentation

• Nausea

• Vomiting

• Loss of appetite

• Belching

• Bloating

• Acute abdominal pain

• Abdominal discomfort

• Fever

• Chills

• Hiccups

Investigations

• Endoscopic evidence of gastric mucosal inflammation

• Histological evidence of chronic active inflammation on biopsy specimens

Non-pharmacological treatment

• Reduce the use of drugs known to cause gastritis (e.g., NSAIDs and alcohol).

• Stop smoking.

• Reduce fatty, spicy, and deep-fried foods.

Pharmacological treatment

H. pylori eradication

• Triple therapy for H. pylori eradication if infection is confirmed.

• Refer to the H. pylori eradication section.

Supportive treatment

• Administer fluids and electrolytes as required, particularly in patients with vomiting.

Acid suppression therapy

• Pantoprazole (IV) 40 mg every 6 hours for 2–3 days

OR

• Esomeprazole (IV) 40 mg every 12 hours for 2–3 days

Antiemetic therapy

• Metoclopramide (IM) 10 mg every 12 hours when required for cases presenting with intractable vomiting

Step-down therapy

• Switch to an oral proton pump inhibitor (PPI) once the patient can tolerate oral intake.

Referral

Refer to the next level of care with appropriate expertise and facilities for complicated cases or patients presenting with alarm features, including:

• Anaemia

• Haematemesis (vomiting blood)

• Weight loss

Refer to the complete list of alarm features under the GERD section.