Reduction of nonsteroidal anti-inflammatory drug (NSAID) and alcohol use can reduce the incidence and severity of gastritis.[38]Chamberlain CE. Acute hemorrhagic gastritis. Gastroenterol Clin North Am. 1993 Dec;22(4):843-73.
http://www.ncbi.nlm.nih.gov/pubmed/7905865?tool=bestpractice.com
Patients at increased risk for NSAID-related gastrointestinal (GI) complications include those with a prior history of a GI event (ulcer, hemorrhage), age over 60 years, high dosage of NSAIDs, and concurrent use of corticosteroids or anticoagulants.[27]Hernández-Díaz S, Rodríguez LA. Association between nonsteroidal anti-inflammatory drugs and upper gastrointestinal tract bleeding/perforation: an overview of epidemiologic studies published in the 1990s. Arch Intern Med. 2000 Jul 24;160(14):2093-9.
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/485416
http://www.ncbi.nlm.nih.gov/pubmed/10904451?tool=bestpractice.com
[28]Masclee GM, Valkhoff VE, Coloma PM, et al. Risk of upper gastrointestinal bleeding from different drug combinations. Gastroenterology. 2014;147(4):784-92.
https://www.gastrojournal.org/article/S0016-5085(14)00768-9/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/24937265?tool=bestpractice.com
Caution in the use of NSAIDs and careful monitoring of these patients is advised.[39]National Institute for Health and Care Excellence. Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management. Oct 2019 [internet publication].
https://www.nice.org.uk/guidance/cg184
Critically ill patients are at risk of developing stress-induced GI bleeding.[8]Martindale RG. Contemporary strategies for the prevention of stress-related mucosal bleeding. Am J Health Syst Pharm. 2005 May 15;62(10 Suppl 2):S11-7.
http://www.ncbi.nlm.nih.gov/pubmed/15905595?tool=bestpractice.com
The main risk factors for stress-induced GI bleeding are mechanical ventilation for >48 hours and the presence of a coagulopathy (platelet count <50 × 10³/microliter, partial thromboplastin time >2 times the upper limit of the normal range, international normalized ratio >1.5).[8]Martindale RG. Contemporary strategies for the prevention of stress-related mucosal bleeding. Am J Health Syst Pharm. 2005 May 15;62(10 Suppl 2):S11-7.
http://www.ncbi.nlm.nih.gov/pubmed/15905595?tool=bestpractice.com
For patients at risk, prophylactic therapy with H2 antagonists or a proton-pump inhibitor (PPI) has demonstrated efficacy.[40]Moayyedi PM, Lacy BE, Andrews CN, et al. ACG and CAG clinical guideline: management of dyspepsia. Am J Gastroenterol. 2017;112(7):988-1013.
https://journals.lww.com/ajg/fulltext/2017/07000/acg_and_cag_clinical_guideline__management_of.10.aspx
http://www.ncbi.nlm.nih.gov/pubmed/28631728?tool=bestpractice.com
Sucralfate or misoprostol are alternative treatments to prevent stress ulcerations of the gastric mucosa in patients at risk.[8]Martindale RG. Contemporary strategies for the prevention of stress-related mucosal bleeding. Am J Health Syst Pharm. 2005 May 15;62(10 Suppl 2):S11-7.
http://www.ncbi.nlm.nih.gov/pubmed/15905595?tool=bestpractice.com
For patients undergoing gastric surgery for malignancy or peptic ulcer disease, use of a Roux-en-Y limb or isoperistaltic jejunal interposition procedure reduces the risk of iatrogenic bile-reflux gastritis and esophagogastric injury.[4]Bondurant FJ, Maull KI, Nelson HS Jr, et al. Bile reflux gastritis. South Med J. 1987 Feb;80(2):161-5.
http://www.ncbi.nlm.nih.gov/pubmed/3810208?tool=bestpractice.com
[7]McAlhany JC Jr, Hanover TM, Taylor SM, et al. Long-term follow-up of patients with Roux-en-Y gastrojejunostomy for gastric disease. Ann Surg. 1994 May;219(5):451-5.
http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1243166&blobtype=pdf
http://www.ncbi.nlm.nih.gov/pubmed/8185395?tool=bestpractice.com