Gastritis

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Chronic Peptic Ulcer Disease

Description

Most peptic ulcers occur in the stomach or proximal duodenum but can also occur in the oesophagus (with oesophageal reflux).

Signs and Symptoms

  • Epigastric pain
  • Indigestion
  • Flatulence
  • Heartburn
  • Anorexia: weight loss may occur

Investigations

  • Endoscopy
  • Barium meal

NB: Many patients, particularly the young presenting with indigestion, can be treated symptomatically for 4-5 weeks without investigation.

Treatment

Refer to section on Gastritis where available or as below

Anti-acids

  • Magnesium trisilicate compound chewable tablet 250 - 500mg to chew when required or
  • Aluminium hydroxide chewable tablet 500mg - 1g to chew when required

        OR

  • Magnesium trisilicate suspension 250mg with dried Aluminium (indicate strength /per ml)hydroxide 120mg 10ml orally 3 times daily OR
  • Aluminium hydroxide (dried Aluminium hydroxide 500mg) 5 - 10ml orally 4 times daily; Children 6 - 12 years 5ml orally 3 times daily.
  • Adults 1 - 4 tablets to be chewed 4 times daily between meals and at bedtime or as required.

Anti-Secretory Agent

  1. H2–receptor antagonists

Cimetidine 400mg tablets twice daily (with breakfast and at night) or 800mg at night for at least 4 weeks.

Maintenance 400mg at night or 400mg morning and night.

Reflux oesophagitis:

  • Cimetidine 400mg 4 times daily for 4 – 8

        OR

  • Ranitidine 150mg tablets twice daily (with breakfast and at night) or 300mg at night for 4 – 8 weeks, up to 6 weeks in chronic episodic dyspepsia. Maintenance 150mg at night.
  • Ranitidine 150mg twice daily or 300mg at night for up to 8 weeks or if necessary 12 weeks

        OR

  • Famotidine 20-40mg once daily up to 8 weeks

b. Proton pump inhibitors

  • Omeprazole 20mg tablets daily for 4 weeks followed by a further 4 – 8 weeks if not fully
  • Long term management of acid reflux Omeprazole 10mg daily increasing up to 20mg if symptoms return. Not recommended for children under 3kg
  • Children under 3kg - 5kg 0.7 to 1.4mg/kg daily
  • Child 5 to 10kg: 5mg once daily in morning, child 10kg to 20kg: 10mg once daily in morning

        OR

  • Esomeprazole 20-40mg once daily for 4-8 weeks

        OR

  • Rabeprazole 20mg twice daily for 4-8 weeks

c. Tripotassium dicitrabismuthate (Bismuth chelate)

  • Liquid 12mg/5ml. 10ml twice daily or 5ml 4 times daily for 28 days followed by a further 28 days if necessary. Not recommended for children.
  • Tablets 120mg. 2 tablets twice daily or 1 tablet 4 times daily for 28 days followed by a further 28 days if necessary.

d. Triple therapy regimens

14-day regimen

  • Amoxycillin 1g 2 times daily Plus
  • Metronidazole 400mg 2 times daily Plus
  • Omeprazole 20mg twice daily or 40mg once daily for 14 days

        OR

 Alternative: Clarithromycin 500mg daily twice daily Plus Metronidazole 400mg (or Tinidazole 500mg) twice daily for 7 days Plus Omeprazole 20mg twice daily for 14 days.

Complications

  • Change of the oesophageal mucosa (Barrett’s oesophagus) which is
  • Anaemia and frank haemorrhage
  • Recurrent aspiration pneumonia when stricture formation is present
  • Perforation of peptic ulcer
  • Pyloric stenosis