Gastrointestinal Nursing.pdf

48 Chapter 4status. In gastric ulcer disease endoscopy must be repeated after suitable treatmentto confirm that the ulcer has healed.Management of peptic ulcer diseaseHP eradication is the cornerstone of modern therapy for peptic ulcers, as thiswill successfully prevent relapse and eliminate the need for long-term therapyin the majority of patients. All patients with proven acute or chronic duodenalulcer disease, and those with gastric ulcers who are HP-positive, should beoffered eradication therapy as first-line treatment. Treatment is based upon aproton pump inhibitor taken simultaneously with two antibiotics for a periodof seven days. Compliance, side-effects and metronidazole resistance influencethe success of therapy.Nurses involved in the care of patients with peptic ulcer disease mayinclude behavioural modification techniques by incorporating the followingrecommendations:• Cease smoking.• NSAIDs should be avoided.• Alcohol should be taken in moderation.• No specific dietary advice is required.At present, the most frequently used medical treatment for the suppressionof gastric acid secretion in peptic ulcer disease is the administration of protonpump inhibitors. These inhibitors are effective in decreasing gastric acid byinhibiting the enzyme responsible for the final step of acid secretion, hydrogenpotassiumadenosinetriphosphatase (ATPase) in the parietal cell membrane.After a few days of treatment, virtual achlorhydria is achieved and rapid healingof both gastric and duodenal ulcers follows. Omeprazole and lansoprazoleare important components of HP eradication regimens. Proton pump inhibitorsare also much more effective than H2 antagonists for the healing and maintenanceof reflux oesophagitis.Other drugs available for the short-term management of peptic ulcersymptoms and other dyspeptic disorders include antacids and histamine H 2receptor antagonists. These can be purchased without prescription in the UK.Antacids act to neutralise gastric acid and strengthen the gastric mucosalbarrier. They are widely available for self-medication and are used for relief ofminor dyspeptic symptoms. Calcium compounds cause constipation, whilemagnesium-containing agents cause diarrhoea.Reduction of acid secretion in peptic ulcer disease can be effected by antagonisingthe action of histamine. Using histamine H 2 receptor antagonists,symptoms remit promptly, usually within days of starting treatment, and 80%of duodenal ulcers will heal after four weeks. These drugs do not inhibit acidsecretion to the same degree as the proton pump inhibitors but are useful forthe short-term management of reflux oesophagitis.