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Management of peptic ulcer disease not related to Helicobacter
Author(s) -
Yeomans Neville D
Publication year - 2002
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1046/j.1440-1746.2002.02726.x
Subject(s) - medicine , aspirin , misoprostol , helicobacter pylori , peptic , proton pump inhibitor , gastroenterology , disease , peptic ulcer , omeprazole , surgery , pregnancy , abortion , biology , genetics
Most peptic ulcers not due to Helicobacter pylori are caused by non‐steroidal anti‐inflammatory drugs (NSAID), among which an important subset are due to vascular protective (‘low‐dose’) aspirin therapy. Non‐steroidal anti‐inflammatory drugs ulcers heal quite quickly when treated with a proton pump inhibitor (PPI), even though the NSAID is continued. If the NSAID can be stopped, the ulcers heal readily with either a PPI or a histamine H 2 ‐receptor antagonist (H 2 ‐RA). If anti‐inflammatory treatment is still needed after ulcers are healed, prophylactic co‐therapy with a PPI or misoprostol will reduce the risk of ulcer recurrence by about 60–80%. The alternative of switching to a highly selective cyclooxygenase‐2 inhibitor has been shown to reduce the risk of a complicated ulcer by about 50–60%, unless low‐dose aspirin treatment needs to be given as well for vascular disease. Idiopathic ulcers are becoming more frequent as H. pylori prevalence falls. Some may be sequelae of previous NSAID ulceration even though the NSAID has been ceased and the original ulcer had healed. These are best treated with an H 2 ‐RA or a PPI, followed by long‐term maintenance with either of these (often in half the healing dosage) to prevent recurrence. Ulcers due to Zollinger–Ellison syndrome and other hypergastrinemia syndromes are rare, and largely beyond the scope of this review. © 2002 Blackwell Publishing Asia Pty Ltd