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Gastritis, Chronic - Chronic gastritis, by definition, is a histopathological entity characterized by chronic inflammation of the stomach mucosa. Gastritis's can be classified based on the underlying etiologic agent (eg, Helicobacter pylori, bile reflux, nonsteroidal anti-inflammatory drugs [NSAIDs], autoimmunity, allergic response) and the histopathological pattern, which may suggest the etiologic agent and clinical course (eg, H pylori;associated multifocal atrophic gastritis). Other classifications are based on the endoscopic appearance of the gastric mucosa (eg, varioliform gastritis).


Treatment of gastritis depends on the specific cause and may include lifestyle changes, medications or, rarely, surgery to treat an underlying disease or condition.

Medications for stomach acid
Stomach acid further irritates inflamed tissue in your stomach, causing pain. That's why, for most types of gastritis, treatment involves taking drugs to reduce or neutralize stomach acid, such as:

  • Antacids. Antacids (Maalox, Mylanta, others) in liquid or tablet form are a common treatment for mild gastritis. Antacids neutralize stomach acid and can provide fast pain relief.

  • Acid blockers. If you're troubled by excessive acid and antacids fail to provide relief, your doctor may give you a prescription drug such as cimetidine (Tagamet), ranitidine (Zantac), nizatidine (Axid) or famotidine (Pepcid). These drugs decrease the amount of acid your stomach produces.

  • Proton pump inhibitors. An even more effective way to reduce stomach acid is to shut down the acid "pumps" within acid-secreting stomach cells. Proton pump inhibitors reduce acid by blocking the action of these tiny pumps. They include the prescription medications omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex) and esomeprazole (Nexium). Another similar drug, pantoprozole (Protonix), can be taken orally or administered intravenously in the hospital. Proton pump inhibitors also appear to inhibit H. pylori activity.

  • Cytoprotective agents. These medications are designed to help protect the tissues that line your stomach and small intestine. They include the prescription medications sucralfate (Carafate) and misoprostol (Cytotec). If you're taking NSAIDs regularly, your doctor may suggest that you also take one of these medications to protect your stomach. Another cytoprotective agent is bismuth subsalicylate (Pepto-Bismol). In addition to protecting the lining of your stomach and intestines, bismuth preparations appear to inhibit H. pylori activity.

Medications to treat H. pylori
Gastritis caused by H. pylori infection is treated with antibiotics, sometimes given in combination with a proton pump inhibitor. Some such combinations of medications are highly effective, killing the bacteria up to 90 percent of the time.

Antibiotics most commonly prescribed for treatment of H. pylori include amoxicillin (Amoxil, Wymox), clarithromycin (Biaxin), metronidazole (Flagyl) and tetracycline (Achromycin V). Some pharmaceutical companies package a combination of two antibiotics together, with an acid suppressor or cytoprotective agent, specifically for treatment of H. pylori infection. These combination treatments are sold under the brand names Prevpac and Helidac.

You'll need to take antibiotics for only one to two weeks, depending on the type and number your doctor prescribes. Other medications prescribed in conjunction with antibiotics, such as a proton pump inhibitor, generally are taken for a longer period.

To ensure that H. pylori has been eliminated, your doctor may test you after treatment. The breath test and the stool test are the preferred ways to check for remaining signs of H. pylori. The blood test may remain positive for months or longer despite the fact that the bacteria have been eliminated.

Discontinuing medications
If the gastritis appears to be a side effect of a medication that you're taking, your doctor may recommend that the medication be replaced with other drugs. For example, newer NSAIDs called COX-2 inhibitors — examples of which include celecoxib (Celebrex) and rofecoxib (Vioxx) — cause fewer stomach problems than do traditional NSAIDs and may work for you. But talk to your doctor before stopping any prescribed drug on your own.

Gastritis > 1 > 2 > 3 > 4

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