Erosive Gastritis

Patients with mild erosive gastritis are often asymptomatic, although some complain of dyspepsia, nausea, or vomiting.

Often, the first sign is hematemesis, melena, or blood in the nasogastric aspirate, usually within 2 to 5 days of the inciting event. Bleeding is usually mild to moderate, although it can be massive if deep ulceration is present, particularly in acute stress gastritis.

Acute and chronic erosive gastritis are diagnosed endoscopically.

In severe gastritis, bleeding is managed with IV fluids and blood transfusion as needed. Endoscopic hemostasis should be attempted, with surgery a fallback procedure if bleeding cannot be controlled endoscopically. Angiography is unlikely to stop severe gastric bleeding because of the many collateral vessels supplying the stomach. Acid-suppressing therapy Medications for the Treatment of Gastric Acidity Medications for decreasing acidity are used for peptic ulcer, gastroesophageal reflux disease (GERD), and many forms of gastritis. Some medications are used in regimens for treating Helicobacter... read more should be started if the patient is not already receiving it.

For milder gastritis, removing the offending agent and using medications to reduce gastric acidity (see Medications for the Treatment of Gastric Acidity Medications for the Treatment of Gastric Acidity Medications for decreasing acidity are used for peptic ulcer, gastroesophageal reflux disease (GERD), and many forms of gastritis. Some medications are used in regimens for treating Helicobacter... read more ) to limit further injury and promote healing may be all that is required.

Prophylaxis with acid-suppressive medications can reduce the incidence of acute stress gastritis. However, it mainly benefits certain high-risk intensive care unit patients, including those with severe burns, central nervous system trauma, coagulopathy, sepsis, shock, multiple trauma, mechanical ventilation for > 48 hours, chronic liver disease, acute kidney injury, hepatic or renal failure, multiorgan dysfunction, and history of peptic ulcer or gastrointestinal bleeding.

A 2020 guideline for gastrointestinal bleeding prophylaxis for critically ill patients recommends that in most critically ill patients the benefit of acid suppression must be weighed against the risk of pneumonia. The guideline includes a calculator to help assess the risk of gastrointestinal bleeding. There is a possible increased risk of nosocomial pneumonia in critically ill patients receiving acid suppression. A recent meta-analysis concluded that proton pump inhibitors (PPIs) and histamine-2 receptor antagonists may increase the risk of pneumonia (absolute increases 5% for PPIs and 3.4% for histamine-2 receptor antagonists; 1 Treatment references Erosive gastritis is gastric mucosal erosion caused by damage to mucosal defenses. It is typically acute, manifesting with bleeding, but may be subacute or chronic with few or no symptoms. Diagnosis... read more ). However, a previous large clinical study of a PPI for patients at risk of gastrointestinal bleeding in the intensive care unit found no increased incidence of pneumonia (2 Treatment references Erosive gastritis is gastric mucosal erosion caused by damage to mucosal defenses. It is typically acute, manifesting with bleeding, but may be subacute or chronic with few or no symptoms. Diagnosis... read more ). The guideline further recommends using a PPI rather than a histamine-2 receptor antagonist (weak recommendation) and recommends against using sucralfate.

Early enteral feeding also can decrease the incidence of bleeding.

Acid suppression is not recommended for patients simply taking nonsteroidal anti-inflammatory drugs unless they have previously had an ulcer.

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