Treatment of Gastritis

Initial Assessment and H. pylori Testing

The American Gastroenterological Association recommends testing all gastritis patients for H. pylori using non-invasive methods such as urea breath test or monoclonal stool antigen test 1, 2
The American Gastroenterological Association advises against serological testing for confirming eradication as it remains positive after successful treatment 1
If atrophic gastritis is present on histology, the American Gastroenterological Association recommends checking antiparietal cell antibodies and anti-intrinsic factor antibodies to identify autoimmune etiology 1, 2

The American Gastroenterological Association recommends bismuth quadruple therapy for 14 days as the preferred first-line treatment due to increasing antibiotic resistance to clarithromycin and metronidazole 3
The American Gastroenterological Association suggests using antibiotics from the "Access group" (amoxicillin, tetracycline, metronidazole) rather than "Watch group" antibiotics (clarithromycin, levofloxacin) when possible to minimize resistance development 3
The American College of Gastroenterology recommends confirming eradication 4-6 weeks after completing therapy using non-serological testing 1, 4

The American Gastroenterological Association recommends high-potency PPIs taken 30 minutes before meals as first-line for symptom relief and mucosal healing 4, 5
The American Gastroenterological Association suggests using esomeprazole 20-40 mg twice daily or rabeprazole 20 mg twice daily for acid suppression 4, 5

The American Gastroenterological Association recommends discontinuing NSAIDs immediately if possible 4, 5
The American Gastroenterological Association suggests testing and treating H. pylori before initiating long-term NSAID therapy in all patients, especially those with prior peptic ulcer history 6, 5

The American Gastroenterological Association recommends screening for vitamin B-12 and iron deficiencies in all patients, particularly with corpus-predominant disease 1, 2
The American Gastroenterological Association suggests screening for autoimmune thyroid disease as concomitant autoimmune disorders are common 1, 2

The American Gastroenterological Association recommends risk stratification using OLGA staging to determine surveillance intervals and cancer prevention strategies 6
The American Gastroenterological Association suggests performing endoscopy every 3 years for advanced atrophic gastritis (extensive anatomic distribution and high histologic grade) 1, 2

The American Gastroenterological Association recommends using antacids for rapid, temporary symptom relief and can be used on-demand for breakthrough symptoms 4, 5

The American Gastroenterological Association advises against using antibiotic therapy <14 days duration as this significantly reduces eradication rates 4, 5
The American Gastroenterological Association recommends confirming H. pylori eradication with non-serological testing rather than relying on symptom resolution alone 4, 5