How is acute gastritis treated?

Updated: Jul 12, 2020
  • Author: Sarah El-Nakeep, MD; Chief Editor: BS Anand, MD  more...
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Administer fluids and electrolytes as required, particularly if the patient is vomiting.

Discontinue the use of drugs known to cause gastritis (eg, nonsteroidal anti-inflammatory drugs [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. [17] This suggests that better management of NSAID use should be discussed with older patients to reduce NSAID-associated upper gastrointestinal 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 has low CYP2C19-inhibiting properties. [18, 19]

PPIs when used with clopidogrel will increase the risk of mycocardial infarction and stent thrombosis, but this combination will not increase the risk of death or bleeding after percutaneous coronary intervention according to a 2019 meta-analysis. [20] Pantoprazole and lansoprazole have shown the least interaction with clopidogrel and appear to be safer than esomeprazole and omeprazole according to the latest FDA recommendations. [20]

Rebamipide is a drug that provides mucosal protection through activation of prostagrandins and inhibition of neutrophil response in the stomach lining, thus increasing the mucosal healing in NSAID-induced gastritis and H pylori infection. In separate 2018 and 2019 meta-analyses, rebamipide was effective when combined with H pylori eradication dual-therapy regimens, although its effect could be limited by ethnicity (ie, effective in Asian but not Caucasoid populations). This drug is not FDA approved, but it is used extensively in Korea, Japan, and Russia. [21, 22]

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