Alcoholic Gastritis

Alcoholic Gastritis – Treatment Options

Introduction
Alcoholic gastritis is inflammation and irritation of the gastric mucosa caused by acute or chronic alcohol consumption. Alcohol directly damages the mucosal lining, increases gastric acid secretion, and impairs protective mechanisms. Patients may present with epigastric pain, nausea, vomiting, bloating, loss of appetite, and in severe cases hematemesis or melena. Chronic gastritis also increases the risk of ulcers and gastrointestinal bleeding. Treatment focuses on eliminating the offending factor, reducing gastric irritation, and promoting mucosal healing.

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1. Causal and Lifestyle Management

• Complete alcohol cessation is the cornerstone of treatment.

• Dietary modifications:

  • Avoid spicy, acidic, or fried foods.

  • Limit caffeine and smoking (both aggravate gastritis).

  • Eat smaller, more frequent meals to reduce gastric irritation.

• Stress reduction and adequate hydration support recovery.

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2. Pharmacological Management

• Acid suppression therapy:

  • Proton pump inhibitors (PPIs): Omeprazole, pantoprazole, esomeprazole – most effective for mucosal healing.

  • H2 receptor antagonists: Ranitidine (less commonly used now), famotidine – reduce gastric acid secretion.

  • Antacids: Provide rapid but short-term relief.

• Mucosal protective agents:

  • Sucralfate: Coats and protects the gastric lining.

  • Misoprostol: Enhances mucosal defenses (less commonly used due to side effects).

• Antiemetics (ondansetron, metoclopramide): For nausea and vomiting.

• Antibiotics: Only if testing confirms Helicobacter pylori infection, which can worsen gastritis.

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3. Management of Complications

• Upper GI bleeding:

  • Hospitalization, IV PPIs, IV fluids, and blood transfusion if severe.

  • Endoscopic intervention (banding, clipping, cauterization) if active bleeding is identified.

• Chronic gastritis with ulcer formation: Requires long-term acid suppression and strict abstinence.

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4. Long-Term Support and Prevention

• Addiction counseling and rehabilitation programs for patients with alcohol use disorder.

• Nutritional supplementation: Vitamins (B-complex, folate, iron) to correct deficiencies.

• Regular follow-up: Monitor for recurrence, peptic ulcer disease, or progression to gastric atrophy.

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Prognosis

• Excellent if alcohol abstinence is achieved early; mucosal healing typically occurs within weeks to months.

• Poor if alcohol consumption continues, with higher risks of ulceration, recurrent bleeding, and gastric cancer.