Treatment of Alcoholic Gastritis

First-Line Interventions

The primary treatment for alcoholic gastritis is complete alcohol abstinence, which must be combined with proton pump inhibitors, nutritional support, and management of associated symptoms, as recommended by the American Gastroenterological Association 1
Alcohol abstinence is the most important and fundamental treatment for alcoholic gastritis, as continued alcohol consumption perpetuates mucosal damage and inflammation, according to the American College of Gastroenterology 1
Proton pump inhibitors (PPIs) should be prescribed to reduce gastric acid secretion and promote mucosal healing, although there are limited specific data on their use in alcoholic gastritis, as stated by the National Comprehensive Cancer Network 2
Nutritional therapy is essential, providing 35-40 kcal/kg/day and protein intake of 1.2-1.5 g/kg/day, as recommended by the European Association for the Study of the Liver 3, 4
For severely ill patients, increase protein intake to 1.5 g/kg/day, as suggested by the American Gastroenterological Association 4

Vitamin and mineral supplementation should be provided alongside nutritional therapy, particularly vitamin A, thiamine, vitamin B12, folic acid, pyridoxine, vitamin D, and zinc, as recommended by the American College of Gastroenterology 1, 4
B-complex vitamins are especially important in alcohol users, according to the European Association for the Study of the Liver 3

For gastrointestinal bleeding related to alcoholic gastritis, endoscopic therapy may be necessary for active bleeding, as stated by the National Comprehensive Cancer Network 5
Angiographic embolization techniques can be considered when endoscopy is not effective, as suggested by the National Comprehensive Cancer Network 5
For nausea and vomiting, dopamine receptor antagonists (prochlorperazine, haloperidol, metoclopramide) can be used, as recommended by the National Comprehensive Cancer Network 2
For persistent symptoms, consider adding 5-HT3 receptor antagonists or anticholinergic agents, as suggested by the National Comprehensive Cancer Network 2

Brief alcohol intervention during hospitalization is strongly recommended to reduce future alcohol consumption, as stated by the American Gastroenterological Association 6, 7
This has been shown to reduce alcohol intake by approximately 41 g/week, according to the American Gastroenterological Association 7
Extended alcohol counseling should be arranged after discharge to maintain abstinence, as recommended by the American Gastroenterological Association 7

Monitor for nutritional deficiencies, which are common in alcoholic patients and can worsen outcomes, as stated by the American College of Gastroenterology 1, 4
Be vigilant for signs of alcohol withdrawal, which may require specific management protocols, as recommended by the American Gastroenterological Association 8
Recognize that alcoholic gastritis often coexists with other alcohol-related conditions, such as alcoholic liver disease, which may require additional management, as stated by the American Association for the Study of Liver Diseases 4, 8

Brief interventions can reduce alcohol consumption by approximately 41 g/week in patients with alcohol-induced gastritis 9
Proton pump inhibitors (PPIs) are more effective than H2-receptor antagonists, which are more effective than placebo for symptomatic relief in patients with alcohol-induced gastritis 10

Thiamine can still be administered orally or enterally in patients with alcohol-related gastritis, though IV route is most efficient for acute deficiency, with a recommended dose of 100-300 mg/day IV for 3-4 days 11

Continue PPI therapy until mucosal healing is confirmed and symptoms resolve, as PPIs are effective in reducing gastric acid secretion and promoting mucosal healing, according to the American Gastroenterological Association 12
In alcohol-dependent patients without advanced liver disease, consider naltrexone or acamprosate combined with counseling to reduce relapse risk, as recommended by the American Association for the Study of Liver Diseases 13

Do not use metoclopramide as monotherapy for GERD-like symptoms in patients with alcoholic gastritis, as it has fair evidence of being ineffective, according to the American Gastroenterological Association 12

Systematic evaluation of alcohol intake should be performed for all patients with suspected alcohol‑related gastritis in both primary care and specialist settings to ensure appropriate diagnosis and management decisions【14, 15】.

In alcohol‑dependent patients without advanced liver disease, oral naltrexone (an opioid antagonist) reduces alcohol craving and lowers the risk of relapse when used as part of a treatment program. 16, 17
Acamprosate, administered together with counseling, diminishes withdrawal symptoms and alcohol craving, and improves maintenance of abstinence in alcohol‑dependent individuals. 16, 17

Naltrexone carries a risk of hepatocellular injury; therefore liver function should be monitored regularly during therapy. 17