Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Recommended first-line treatments for acute gastritis in adults:
- Identify and stop any causative agents such as NSAIDs or other ulcer-inducing medications where possible.
- Offer acid suppression therapy with a proton pump inhibitor (PPI) at full dose for 4 to 8 weeks to promote healing and symptom relief.
- If Helicobacter pylori infection is confirmed, provide first-line eradication therapy consisting of a 7-day, twice-daily regimen of a PPI combined with amoxicillin and either clarithromycin or metronidazole, taking into account previous antibiotic exposure and allergies.
- For patients allergic to penicillin, offer a 7-day triple therapy with a PPI, clarithromycin, and metronidazole; if there is previous exposure to clarithromycin, use a quadruple therapy including a PPI, metronidazole, tetracycline, and bismuth subsalicylate.
- Advise patients on the importance of adherence to the prescribed regimen.
- Arrange follow-up if symptoms are refractory or recurrent after initial treatment.
These treatments aim to reduce gastric acid secretion, eradicate H. pylori if present, and remove contributing factors to allow mucosal healing and symptom resolution.
Example PPI doses recommended include: lansoprazole 30 mg, omeprazole 20–40 mg, esomeprazole 20 mg, pantoprazole 40 mg, or rabeprazole 20 mg.