Travel Reference
In-Depth Information
An uncomplicated ulcer is not usually disabling, although the pain can be substantial,
but is threatening because it may hemorrhage or perforate. These disabling, life-endanger-
ing complications require immediate evacuation to a medical center. (Perforation is dis-
cussed in Chapter 20: Acute Abdominal Pain .)
The characteristic symptom of an ulcer is gnawing pain, usually located in the upper
portionoftheabdomennearthemidline.Thepainisquitelocalized,andthepersonusually
can pinpoint it with a fingertip. Typically, the pain comes on one to four hours after eating
orbetween midnight andtwoo'clock inthemorning.Bland food,milk, orantacids usually
relieve the pain.
The pain is thought to be caused by the effects of stomach acid on the ulcer. Acid is a
factor in all peptic ulcers. Food and antacids tend to neutralize the acid and thus relieve
the pain. The characteristic times at which the pain occurs are the periods when there is no
food in the stomach to counteract the acid. (No explanation has been found for the absence
of pain in the early morning when the stomach is totally empty.)
Treatment of Peptic Ulcers
The basic therapy for ulcers associated with H. pylori is eradication of the infection, but
diagnosis and treatment of such infections are complex endeavors and should be carried
out by a physician. Supplemental ulcer therapy is primarily directed toward reducing the
acidity of the stomach contents. Antacids have been used in the past and are still valuable.
However, newer, more effective approaches include drugs that block the secretion of acid.
Antacids are best taken between meals. Consumption within an hour of other anti-ulcer
drugsshouldbeavoided.Sinceoverdosagewithantacidsisrarelyaproblem,morefrequent
doses may be administered if pain persists. Liquid antacids are more effective than tablets
but are less portable. Many preparations are available.
Antacid therapy became less important after histamine H 2 receptor antagonists (H 2
blockers) became available. Famotidine (Pepcid®), ranitidine (Zantac®), cimetidine
(Tagamet®), and nizatidine (Axid®) are H 2 blockers currently being used; all are equally
effective in appropriate dosage. Famotidine, ranitidine, and cimetidine are now available
without prescription. Famotidine and nizatidine are best taken once a day at bedtime and
are simpler to administer. The other two drugs must be taken more frequently. The most
potentmedicationsnowavailablearetheprotonpumpinhibitors(PPIs)introducedin1989.
Omeprazole (Prilosec®) was the first drug of this class to become available and now is
available without prescription. Esomeprazole (Nexium®), lansoprazole (Prevacid®), pan-
toprazole(Protonix®),andrabeprazole(Aciphex®)areotherpopulardrugsofthistypebut
require a prescription.
Any NSAID being administered must be discontinued. Aspirin in any form must be
strictly avoided; it increases the risk of bleeding fifteen-fold. Smokers with ulcers should
ceasesmokingentirely;attheveryleast,andofmuchlessimpact,theyshouldsubstantially
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