Antisecretory drugs and mucosal protectants

1.3.1 ^-receptor antagonists

1.3.2 Selective antimuscarinics

1.3.3 Chelates and complexes

1.3.4 Prostaglandin analogues

1.3.5 Proton pump inhibitors

Peptic ulceration commonly involves the stomach, duodenum, and lower oesophagus; after gastric surgery it involves the gastro-enterostomy stoma. Healing can be promoted by general measures, stopping smoking and taking antacids and by antisecretory drug treatment, but relapse is common when treatment ceases. Nearly all duodenal ulcers and most gastric ulcers not associated with NSAIDs are caused by Helicobacter pylori.

The management of H. pylori infection and of NSAID-associated ulcers is discussed below.

Helicobacter pylori infection

Eradication of Helicobacter pylori reduces recurrence of gastric and duodenal ulcers and the risk of rebleeding. It also causes regression of most localised gastric muco-sa-associated lymphoid-tissue (MALT) lymphomas. The presence of H. pylori should be confirmed before starting eradication treatment. Acid inhibition combined with antibacterial treatment is highly effective in the eradication of H. pylori; reinfection is rare. Antibiotic-associated colitis is an uncommon risk. For initial treatment, a one-week triple-therapy regimen that comprises a proton pump inhibitor, clarithromycin,

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