Acute Gastritis Management

Initial Treatment Approach

The American College of Gastroenterology recommends starting omeprazole 20 mg once daily before meals for most patients with acute gastritis, which can be increased to 40 mg once daily for more severe cases or inadequate response 1
PPIs should be taken 30 minutes before eating to maximize effectiveness 1
Higher-potency PPIs, such as esomeprazole 20-40 mg twice daily or rabeprazole 20 mg twice daily, may be considered for patients requiring more aggressive acid suppression 1

The American College of Gastroenterology recommends that all patients with gastritis should be tested for H. pylori, and if positive, receive eradication therapy 1
Bismuth quadruple therapy for 14 days is the preferred first-line treatment: PPI (omeprazole 20 mg twice daily) + bismuth + metronidazole + tetracycline 1
The Infectious Diseases Society of America recommends fluid and electrolyte replacement as the cornerstone of treatment for infectious gastroenteritis with vomiting 2
Ondansetron may be given to children >4 years of age and adolescents to facilitate oral rehydration tolerance, though it may increase stool volume 2
Antiemetics are not routinely recommended for children <4 years of age or adults with acute gastroenteritis 2

The American Academy of Pediatrics and the Infectious Diseases Society of America recommend never using loperamide in children under 18 years - deaths have been reported in 0.54% of children given loperamide, all occurring in children <3 years old 2
Loperamide should be avoided in any patient with suspected inflammatory diarrhea or fever regardless of age due to risk of toxic megacolon 2
Failure to test for and eradicate H. pylori leads to persistent infection and complications 1

Surveillance endoscopy every 3 years should be considered in patients who develop advanced atrophic gastritis 1