RISK FACTORS: Age over 60, Exposure to potentially noxious drugs or chemical agents, Hypovolemia, hypoxia (shock), Candidal autoimmune,
GENERAL MEASURES
β’ No specific therapy for gastritis (with the exception of H. pylori infection)
β’ Parenteral fluid and electrolyte supplements required if vomiting prevents food intake
β’ Consider discontinuing NSAIDs or adding misoprostol
DIET Restriction, if any, depends on severity of symptoms (e.g., light, soft diet); avoid caffeine and spicy foods.
PATIENT EDUCATION :
β’ Explanation, reassurance
β’ Smoking cessation
β’ Dietary changes
β’ Relaxation therapy
DRUG(S) OF CHOICE
. Antacids - best given in liquid form, 30 mL 1 hour after meals and at bedtime; useful mainly as an emollient
. H2 receptor antagonists e.g., cimetidine (Tagamet)
- ΒgprimingΒh dose of 300 mg IV, then a steady infusion of 37.5-75 mg per hour, dissolved in the running fluid.
Patients
less severely ill - oral cimetidine 300 mg q6h (or ranitidine [Zantac] or famotidine [Pepcid] or nizatidine [Axid]). Not shown to be clearly superior to antacids.
. Sucralfate (Carafate) 1 g q4-6h on an empty stomach. Rationale uncertain, but empirically helpful.
. Prostaglandins, e.g., misoprostol (Cytotec), can help allay gastric mucosal injury, suggested dosage of 100-
200 MICRO G qid
. To eradicate H. pylori:
. Triple therapy is advised - bismuth (as Pepto-Bismol) 30 mL liquid or 2 tablets qid for 4 weeks plus
metronidazole 250 mg qid for the first week, plus tetracycline 250 mg qid or amoxicillin 250 mg tid for 2-4 weeks OR
. Dual therapy with omeprazole 20 mg bid plus amoxicillin 500 mg qid for 2 weeks
. Short course therapy with 1 week of metronidazole, omeprazole, and clarithromycin bid - 90% effective
PATIENT MONITORING : Gastroscopy should be repeated after 6 weeks if gastritis has been severe or if symptomatic response to treatment has not been achieved
PREVENTION/AVOIDANCE
β’ Patients should be warned of known or potentially injurious drugs or chemical agents
β’ Patients liable to hypovolemia or hypoxia (especially patients confi ned to an intensive care ward) should
receive prophylactic therapy
POSSIBLE COMPLICATIONS: Bleeding from extensive mucosal erosion or ulceration
EXPECTED COURSE/PROGNOSIS :
β’ Most cases clear spontaneously when the cause has been identifi ed and allayed
β’ Recurrence of H. pylori infection may require a repeated course of treatment