A sore that develops on the lining of the oesophagus, stomach or small intestine.Ulcers occur when stomach acid damages the lining of the digestive tract. Common causes include the bacteria H. Pylori and anti-inflammatory pain relievers including aspirin.
Essentials of Diagnosis:-
• Epigastric pain 1/2 to 1 hour after meals or noctur- nal pain, both relieved by food, antacid or vomiting.
• Chronic and periodic symptoms.
• Epigastric tenderness, often with guarding and unila-
teral spasm of rectus over duodenal bulb.
• Ulcer crater or deformity of bulb noted in Barium
• Pylorospasm, gastric hypermotility and irritability
of the bulb with difficulty in retaining the barium are
indirect evidences of duodenal ulcer.
• Gastric analysis shows acid in all cases and hyper-
secretion in some cases.
• Few patients may present with vague dyspepsia or
typical symptoms due to anxiety. • Direct visualisation by endoscopy.
-2 to 3 weeks of rest.
-Nutritious diet taken at regular intervals; restriction
of coffee, tea, cola, beverages, alcohol and smok- ing. First few days with bland liquid diet with gradual change over to soft solid diet in 4 to 8 weeks time.
-Antacids—Digene tablet or Get 2 tab or 2 teaspoon 2-3 hrs after meals.
-Aluminium hydroxide in tablet form being inert is not very useful. Magnesium oxide and Calcium carbonate combinations are best. Magnesium is contraindicated in renal impairment and calcium salts may cause hypercalcaemia (polyuria, poly- dypsia, anorexia, constipation, etc.). Liquid forms are preferable. Initially given hourly then changed to 1 and 3 hours after each meal and at bed time. Antacids may cause phosphate depletion especially the aluminium salts.
-Omeprazole 20 mg od for 1 month. -Parasympatholytics
These are of questionable value as the dose required to produce significant gastric antisecretory effect may cause blurring of vision, urinary retention and constipation. They are helpful in relief of refractory pain and are given 1/2 hour before meal and at bed time. They are contraindicated in glaucoma, gastric ulcer, pyloric stenosis, hiatus hernia, bladder neck obstruction, etc.
H2 Receptor Antagonist
Famotidine 20 mg twice daily. Rantidine 300-600 mg daily for 6 weeks.
Therapy continued for 4 to 6 weeks and then maintenance dose of 300 (Ranitidine)/40(Famotidine) mg at bed time given for six months.
Look for gynaecomastia, galactorrhoea, gout as adverse effects
• Phenylbutazone, Reserpine, Indomethacin and analgesics should be discontinued if possible as they aggravate the condition. To eliminate H.pylori from gastric mucosa-Metrogyl 400 mg tds plus Amoxicillin 250 mg tds for one week.