A Textbook of Clinical Pharmacology and Therapeutics

ulcer recurrence and complications following successful eradi-
cation of the organism. It has been shown that the speed of
ulcer healing obtained with acid-suppressing agents is acceler-
ated if H. pylori eradication is achieved concomitantly.
Moreover, eradication of H. pyloriinfection prior to the com-
mencement of NSAID therapy reduces the occurrence of gas-
tro-duodenal ulcers in patients who have not had previous
exposure to NSAIDs. H. pyloriappears to be associated with
increased risk of gastric cancer of the corpus and antrum.

PRINCIPLES OF MANAGEMENT

The therapeutic objectives are as follows:

• symptomatic relief;


• promotion of ulcer healing;


• prevention of recurrence, once healing has occurred;


• prevention of complications.

GENERAL MANAGEMENT

• Stopping smoking increases the healing rate of
  gastric ulcers and is more effective in preventing the
  recurrence of duodenal ulcers than H 2 -receptor
  antagonists.


• Diet is of symptomatic importance only. Patients usually
  discover for themselves which foods aggravate
  symptoms.


• Avoid ‘ulcerogenic’ drugs, including caffeine(as strong
  coffee or tea), alcohol, aspirinand other NSAIDs
  (paracetamolis a safe minor analgesic in these cases), and
  glucocorticosteroids.

248 ALIMENTARY SYSTEM ANDLIVER

Vagal stimulation

Parietal cell

M 1 -receptor

H 2 -receptor

ATP

Ca^2 

Ca^2 

cAMP

Gastrin

receptor H-ATP

proton pump

H

K

K

Cl

Stomach

lumen

Acetylcholine

Gastrin

Histamine

Gastrin

receptor

Histamine

Mast cell

Figure 34.1:Mechanisms regulating hydrochloric acid secretion.

Key points

Recommendations for eradication of Helicobacter pylori

• duodenal ulcer


• gastric ulcer


• mucosa-associated lymphoid tissue (MALT) lymphoma


• severeH. pylorigastritis.


• patients requiring long-term proton-pump inhibitor
  treatment (risk of accelerated gastric atrophy)


• blind treatment with eradication therapy is not
  recommended.