Medical Management

Healing of ulcers and relief of pain are the two objectives. Antacids like aluminium hydroxide and magnesium hydroxide are most commonly used. The former produces constipation, and the latter diarrhoea in some patients. Antacids could be taken one hour after each meal and at bedtime. Agents preventing the binding of histamine to receptors are very helpful. Acid secretion is lowered. They are taken with meals. Side effects are minimal, though they include rash, gynaecomastia, mental confusion and increasing the action of other drugs. Ranitidine, nizatidine and famotidine are effective. Omperazole is a promising drug. Prostaglandins, which are chemicals present in the body, help ulcers. They reduce acid secretion, enhance mucosal resistance, stimulate blood flow, increase bicarbonate secretion and stimulate cellular regeneration. Other important measures include cessation of smoking and drinking, lifestyle changes to reduce stress (which is probably the most important) and avoidance of painkiller drugs. Within four to six weeks of therapy, most duodenal ulcers heal.

If surgical procedures are undertaken, the area is resected and the remainder sutured for gastric ulcers. In duodenal ulcers, the duodenum is bypassed and the stomach joined with the small intestine (gastro-jejunostomy). There are many side effects: diarrhoea, as the vagus nerve is cut to reduce acid secretion (the vagus nerve controls gastric emptying), nausea, alteration in blood glucose due to the altered anatomy, and anaemia due to malabsorption. The frequency of surgery for both conditions has decreased after advances in medicine.