A-Textbook-of-Clinical-Pharmacology-and-Therapeutics-5th-edition

248 ALIMENTARY SYSTEM AND LIVER
Vagal stimulation
Acetylcholine
Parietal cell
M 1 -receptor
Ca 2
H
Gastrin
receptor
Ca 2
H -ATP
proton pump
Stomach
lumen
Gastrin
K
H 2 -receptor
ATP
cAMP
K
Histamine
Cl
Gastrin
receptor
Mast cell
Histamine
Figure 34.1: Mechanisms regulating hydrochloric acid secretion.
ulcer recurrence and complications following successful eradication
of the organism. It has been shown that the speed of
ulcer healing obtained with acid-suppressing agents is accelerated
if H. pylori eradication is achieved concomitantly.
Moreover, eradication of H. pylori infection prior to the commencement
of NSAID therapy reduces the occurrence of gastro-duodenal
ulcers in patients who have not had previous
exposure to NSAIDs. H. pylori appears to be associated with
increased risk of gastric cancer of the corpus and antrum.
Key points
Recommendations for eradication of Helicobacter pylori
• duodenal ulcer
• gastric ulcer
• mucosa-associated lymphoid tissue (MALT) lymphoma
• severe H. pylori gastritis.
• patients requiring long-term proton-pump inhibitor
treatment (risk of accelerated gastric atrophy)
• blind treatment with eradication therapy is not
recommended.
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, aspirin and other NSAIDs
(paracetamol is a safe minor analgesic in these cases), and
glucocorticosteroids.