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Gastritis and peptic ulcer disease
MEGAN L. FIX AND STEPHEN H. THOMAS
n Agents
n Antacids
n Belladonna alkaloids plus phenobarbital
n Viscous lidocaine
n H2-receptor antagonists
n Proton pump inhibitors
n Sucralfate
n Prokinetics
n Evidence
This chapter groups the clinically distinct, but similarly treated, entities of
gastritis and peptic ulcer disease (GPUD). While some patients with endoscopically
confirmed ulcers or gastritis present to the ED with refractory pain,
in most cases it is not easy to distinguish between the various GI causes of
epigastric pain. In fact, endoscopy trials show that neither clinical gestalt nor
multivariate modeling (using ED-available information) can reliably distinguish
between organic and functional dyspepsia. 1 Consequently, even in
those ED cases for which a GI origin for epigastric pain can be assumed,
diagnostic uncertainty is common. Clinicians treating epigastric pain may
find useful information in some other chapters (e.g. those on biliary tract pain
or gastroesophageal reflux disease [GERD]).
The diagnostic imprecisions of the ED population prompt additional caveats.
First, acute care clinicians trying to apply the literature on epigastric
pain therapy should keep in mind that the typical clinical study subject is one
in whom there is an endoscopically characterized diagnosis – a luxury the
acute care provider must often do without. Second, the interpretation of
dyspepsia studies is influenced by the fact that only since the mid-1990s
has there been a full appreciation of the role of Helicobacter pylori in GPUD
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