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218 Gastritis and peptic ulcer disease
antagonists provide significant pain relief from gastritis within a few days of
instituting therapy, and that side effect rates are low (and more favorable
than seen with sucralfate). 26,28
After antacids and sucralfate, H2-receptor antagonists such as ranitidine
from the second tier for GERD treatment during pregnancy. 29,30 The fetal
safety of the H2-receptor antagonists for GERD is logically extended to the
use of these agents in GPUD.
Since altered gastroduodenal motility is a postulated occasional cause of
gastritis, the prokinetic drugs have been employed to treat GPUD. 31 These are
used less frequently than other therapies mentioned in this chapter, but they
may be a reasonable choice for relief of nonspecific dyspepsia, especially if
H. pylori status is negative or unknown. 32,33 Prokinetic drugs are also recommended
as a first-line alternative to H2-receptor antagonists in elderly patients
with dyspepsia that is nonspecific or not yet endoscopically investigated. 33,34
Trial data suggest that, for patients with nonspecific dyspepsia, the prokinetic
cisapride (10 mg PO BID) slightly outperforms the H2-receptor antagonist
ranitidine (150 mg PO BID) in terms of symptom relief and relapse. 33
Data from an RCT of patients with gastritis suggest that newer prokinetics
such as clebopride are significantly more effective than older agents such
as domperidone. 35 Data from one trial in patients with antral gastritis
indicated that addition of the prokinetic cisapride (10 mg PO QID) augmented
relief afforded by the H2-receptor antagonist famotidine (40 mg PO QD). 36
Though some newer H2-receptor antagonists (e.g. nizatidine) have
prokinetic-like characteristics, data suggest that these characteristics are not
responsible for any significant benefit. 37 Prokinetics may occasionally cause
unwanted CNS or cardiac side effects.
This chapter is not intended to address functional dyspepsia in detail, but
the therapies mentioned for GPUD (particularly PPIs, H2-receptor antagonists)
may be tried for patients with this chronic disorder. 38,39 Unfortunately,
treatments useful for GPUD are often unhelpful in relieving functional dyspepsia,
and those that are helpful are often only marginally so. 40 Available
meta-analysis data suggest that PPIs are preferred for functional dyspepsia
similar to GPUD-like pain. 38 For patients with non-ulcer dyspepsia, two trials
(one of which enrolled only H. pylori-negative subjects) concluded that