Treatment Options for Chronic Gastritis

Chronic gastritis can be managed effectively through two primary approaches: treating the underlying cause and addressing the symptoms. Here is a detailed overview of both methods:

1. Addressing the Underlying Cause

Chronic gastritis often develops due to an imbalance between aggressive factors and the stomach's natural defenses. To treat this, it's essential to reduce aggressive elements such as Helicobacter pylori (H. pylori) infection, medication-induced damage, excessive gastric acid secretion, and bile reflux.

For H. pylori eradication, a 14-day quadruple therapy is typically recommended. This includes bismuth compounds, proton pump inhibitors (PPIs), and two antibiotics. Amoxicillin is often preferred for patients not allergic to penicillin and can be combined with clarithromycin, metronidazole, levofloxacin, tetracycline, or tinidazole. If initial treatment fails, furazolidone may be used as an alternative.

Excess stomach acid can also contribute to chronic gastritis. To manage this, acid-suppressing medications like proton pump inhibitors (e.g., omeprazole, lansoprazole, rabeprazole, pantoprazole, esomeprazole) are commonly prescribed. Another class of drugs, H2 receptor antagonists—such as cimetidine, ranitidine, famotidine, nizatidine, and roxatidine—can also help reduce acid production. In some cases, antacids like aluminum carbonate, aluminum hydroxide, or sodium bicarbonate may be used to neutralize stomach acid.

For bile reflux management, ursodeoxycholic acid can be taken twice daily to convert lipid-soluble bile acids into water-soluble forms, which helps reduce their harmful effects. Prokinetic agents such as mosapride or domperidone may also be beneficial in improving gastric motility and reducing reflux symptoms.

If gastritis is caused by medications like NSAIDs, corticosteroids, or aspirin, mucosal protection strategies should be emphasized. Protective agents include both endogenous and exogenous options such as aluminum-based compounds, bismuth preparations, magnesium formulations, sucralfate, teprenone, and others. Selection should be guided by a healthcare provider based on individual patient needs.

2. Symptom-Based Management

In addition to treating the root cause, symptom relief is crucial. Pain should not be treated with analgesics like acetaminophen or nonsteroidal anti-inflammatory drugs, as they can worsen the condition. Instead, mucosal protectants and acid suppressants can provide relief.

Patients experiencing nausea, vomiting, or bloating due to delayed gastric emptying may benefit from prokinetic drugs that enhance gastrointestinal motility.

Lastly, complementary approaches such as traditional Chinese medicine (TCM) may also be considered under professional guidance. For example, if a TCM practitioner identifies a deficiency-cold syndrome affecting the spleen and stomach, warming herbs may be recommended to support digestive function and alleviate symptoms.

By combining targeted therapies with personalized care, individuals with chronic gastritis can achieve better symptom control and improved quality of life.