THERAPY AND PREVENTION OF GASTRIC-ULCER

After establishing the benign nature of a gastric ulcer, the treatment is primarily medical. This medical therapy is aimed to alleviate symp toms, to heal the ulcer and to prevent relapses. Based on the history of non-steroidal anti-inflammatory drugs (NSAIDs) and the Helicobacter pylori-status, gastric ulcer patients can be divided into four catego ries (1) H. pylori positive plus NSAID-use, (2) H. pylori positive wit hout NSAID use, (3) NSAID use with negative H. pylori-status, (4) Nega tive H. pylori-status and no NSAID use. Patients taking NSAIDs should stop this therapy if possible. Patients with gastric H. pylori infecti on should be treated by a regimen of a proton pump inhibitor with at l east two appropriate antibiotics. This treatment will result in early alleviation of symptoms, rapid healing of the ulcer and prophylaxis of ulcer relapse. In patients with gastric ulcer who cannot stop NSAIDs, maintenance therapy with prostaglandins or potent antisecretory drugs should be considered. The few patients with gastric ulcer who do not take NSAIDs and do not have gastric H. pylori infection should be trea ted by antisecretory drugs, and they should be carefully followed endo scopically to exclude malignant (carcinoma, lymphoma) or non-peptic (C rohn's disease) disease. All patients with gastric ulcer should be re- endoscoped to verify complete ulcer healing. Surgery may be considered in gastric ulcer patients with complications, in those with severe dy splasia of the gastric mucosa, and in those who are not able or willin g to take the medication.