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Treatment of Gastric Ulcer: What Is Old and What Is New

Treatment of Gastric Ulcer: What Is Old and What Is New Abstract • The rational treatment of gastric ulcer (GU) requires both an understanding of the various causative factors responsible for what is best considered a spectrum of disorders, as well as a familiarity with the newer antisecretory and cytoprotective therapies that are available. Gastric ulcers that fulfill the criteria to be peptic ulcers (ie, occur in the antrum in the presence of excess luminal acid, with or without a coexisting duodenal ulcer) are best treated with a histamine H2-receptor antagonist. For GUs that develop in the setting of normal or reduced acid output, or those that occur as a result of direct (ie, drug-induced or bile acid-related) mucosal injury, use of a cytoprotective agent (eg, sucralfate) is the treatment of choice. Any GU that falls to heal within 12 to 15 weeks should be carefully examined to exclude the presence of a malignant neoplasm and should be considered for surgical resection. (Arch Intern Med 1983;143:264-274) References 1. Kirsner JB, Clayman CB, Palmer WL: The problem of gastric ulcer. Arch Intern Med 1959;104:995-1015.Crossref 2. Kurata JH: Time trends, in Grossman MI (moderator): Peptic ulcer: New therapies, new diseases. Ann Intern Med 1981;95:609-610.Crossref 3. Richardson CT: Gastric ulcer , in Sleisenger MH, Fortran JS (eds): Gastrointestinal Disease , ed 2. Philadelphia, WB Saunders Co, 1978, chap 51. 4. Isenberg JI: Peptic ulcer. DM , (December) 1981, pp 1-58. 5. Watkinson G: The incidence of chronic peptic ulcer found at necropsy. Gut 1960;1:14-18.Crossref 6. Kirk RM: Are gastric and duodenal ulcers separate diseases or do they form a continuum?, in Ginsberg AL (ed): The ulcer controversy. Dig Dis Sci 1981;26:149-154.Crossref 7. Grossman MI: Peptic Ulcer: A Guide for the Practicing Physician . Chicago, Year Book Medical Publishers, 1981. 8. Gillies M, Skyring A: Gastric ulcer, duodenal ulcer and gastric carcinoma: A case-control study of certain social and environmental factors. Med J Aust 1968;2:1132-1136. 9. Piper DW, McIntosh JH, Ariotti DE, et al: Analgesic ingestion and chronic peptic ulcer. Gastroenterology 1981;80:427-432. 10. Cameron AJ: Aspirin and gastric ulcer. Mayo Clin Proc 1975;50:565-570. 11. Silvoso GR, Ivey KJ, Butt JH, et al: Incidence of gastric lesions in patients with rheumatic disease on chronic aspirin therapy. Ann Intern Med 1979;92:517-520.Crossref 12. Cooke AR: The role of the mucosal barrier in drug-induced gastric ulceration and erosion. Dig Dis Sci 1976;21:155-164.Crossref 13. Porter LE: The gastrointestinal tract, in: Van Thiel DH (moderator): Gastrointestinal and hepatic manifestations of chronic alcoholism. Gastroenterology 1981;81:596-599. 14. Lanza FL, Royer GL, Nelson RS, et al: The effects of ibuprofen, indomethacin, aspirin, naproxen, and placebo on the gastric mucosa of normal volunteers: A gastroscopic and photographic study. Dig Dis Sci 1979;24:823-828.Crossref 15. Schwartz K: Ueber penetrierende magen und jejunalgeschwure. Beitr Klin Chir 1910;67:96-128. 16. Sogge MR, Butler ML: Reassessment of the management of benign gastric ulcer with achlorhydria. J Clin Gastroenterol 1981;3:13-15.Crossref 17. Rovelstad RA: The incompetent pyloric sphincter: Bile and mucosal ulcerations. Dig Dis Sci 1976;21:165-172.Crossref 18. Davenport HW: Damage to the gastric mucosa: Effects of salicylates and stimulation. Gastroenterology 1965;49:189-196. 19. Kivilaakso E, Silen W: Pathogenesis of experimental gastric-mucosal injury. N Engl J Med 1979;301:364-369.Crossref 20. Chung RSK, Field M, Silen W: Effects of methylprednisolone on hydrogen ion absorption in the canine stomach. J Clin Invest 1978;62:262-270.Crossref 21. Meyer JH: Altered gastric motility, in Grossman MI (moderator): Peptic ulcer: New therapies, new diseases. Ann Intern Med 1981;95:615-616.Crossref 22. Davidson ED, Hersh T: Bile reflux gastritis: Contribution of inadequate gastric emptying. Am J Surg 1975;130:514-518.Crossref 23. Moody FG, Cheung LY, Simons MA, et al: Stress and the acute gastric mucosal lesion. Dig Dis Sci 1976;21:148-154.Crossref 24. Czaja AJ, McAlhany JC, Pruitt BA Jr: Acute gastroduodenal disease after thermal injury: An endoscopic evaluation of incidence and natural history. N Engl J Med 1974;291:925-929.Crossref 25. Laufer I: Introduction, Double Contrast Gastrointestinal Radiology With Endoscopic Correlation . Philadelphia, WB Saunders Co, 1979, pp 1-9. 26. Wenger J, Brandborg LL, Spellman FA: Cancer: I. Clinical aspects. The Veterans Administration Cooperative Study on Gastric Ulcer. Gastroenterology 1971;61:598-605. 27. Dekker W, Tytgat GN: Diagnostic accuracy of fiber-endoscopy in the detection of upper intestinal malignancy: A follow-up analysis. Gastroenterology 1977;73:710-714. 28. Graham DY, Schwartz JT, Cain D, et al: Prospective evaluation of biopsy number in the diagnosis of esophageal and gastric carcinoma. Gastroenterology 1982;82:228-231. 29. Baron JH: When should a clinician perform gastric analysis? J Clin Gastroenterol 1981;3:87-89.Crossref 30. Eisenband RM, Wenger J: Endoscopic estimate of gastric acid secretion. J Clin Gastroenterol 1981;3:287-290.Crossref 31. Herrmann RP, Piper DW: Factors influencing healing rates of chronic gastric ulcer. Am J Dig Dis 1973;18:1-6.Crossref 32. Piper DW, Hunt J, Heap TR: The healing rate of chronic gastric ulcer in patients admitted to hospital. Scand J Gastroenterol 1980;15:113-117.Crossref 33. Goldberg SJ, Smith CL, Connell AM: Emotion-related gastritis. Am J Gastroenterol 1976;65:41-45. 34. Piper DW, Greig M, Thomas J, et al: Personality pattern of patients with chronic gastric ulcer: Study of neuroticism and extroversion in a gastric ulcer and a control population. Gastroenterology 1977;73:444-446. 35. Davis WD Jr: Treatment of uncomplicated gastric ulcer. Dig Dis Sci 1976;21:190-193.Crossref 36. Doll R, Friedlander H, Pygott F: Dietetic treatment of peptic ulcer. Lancet 1956;2:5-9.Crossref 37. Ippoliti AF, Maxwell V, Isenberg JI: The effect of various forms of milk on gastric-acid secretion: Studies in patients with duodenal ulcer and normal subjects. Ann Intern Med 1976;84:286-289.Crossref 38. Spiro HM: Is milk all that bad for the ulcer patient? J Clin Gastroenterol 1981;3:219-220.Crossref 39. Hollander D, Harlan J: Antacids vs placebo in peptic ulcer therapy: A controlled, double-blind investigation. JAMA 1973;226:1181-1185.Crossref 40. Doll R, Price AV, Pygott F, et al: Continuous intragastric milk drip in treatment of uncomplicated gastric ulcer. Lancet 1956;1:70-73.Crossref 41. Morrisey JF, Barreras RF: Antacid therapy. N Engl J Med 1974;290:550-554.Crossref 42. Hurwitz A: Antacid therapy and drug kinetics. Clin Pharmacokinet 1977;2:269-280.Crossref 43. Steinberg WM, Lewis JH, Katz DM: Antacids inhibit absorption of cimetidine. N Engl J Med 1982;307:400-404.Crossref 44. Ingelfinger FJ: Anticholinergic therapy of gastrointestinal disorders. N Engl J Med 1963;268:1454-1457.Crossref 45. Baume PE, Hunt JH, Piper DW: Glycopyrronium bromide in the treatment of chronic gastric ulcer. Gastoenterology 1972;63:399-406. 46. Greenblatt DJ, Shader RI: Anticholinergics. N Engl J Med 1973;288:1215-1219.Crossref 47. Winship DH: Cimetidine in the treatment of duodenal ulcer: Review and commentary. Gastroenterology 1978;74:402-406. 48. Guth P, Aures D, Paulsen G: Topical aspirin plus HCI gastric lesions in the rat: Cytoprotective effect of prostaglandin, cimetidine and probanthene. Gastroenterology 1979;76:88-93. 49. Bader JP, Morin T, Bernier JJ, et al: Treatment of gastric ulcer by cimetidine: A multicenter trial , in Burland WL, Simkins MA, (eds): Cimetidine: Proceedings of the Second International Symposium on Histamine H2-Receptor Antagonists . Amsterdam, Exerpta Medica, 1977, pp 287-292. 50. Freston JW: Cimetidine in the treatment of gastric ulcer: Review and commentary. Gastroenterology 1978;74:426-430. 51. Fordtran JJ, Dyck WP, Englert E Jr, et al: Round table discussion on gastric ulcer. Gastroenterology 1978;74:431-434. 52. Isenberg J, Elashoff J, Sandersfeld M, et al: Double-blind comparisons of cimetidine and low-dose antacid versus placebo in the healing of benign gastric ulcer, abstracted. Gastroenterology 1982;82:1090. 53. Akdamar K, Dyck W, Englert E, et al: Cimetidine versus placebo in the treatment of benign gastric ulcer, abstracted. Gastroenterology 1981;80:1098. 54. Jensen KB, Mollmann K-M, Rahbek I, et al: Prophylactic effect of cimetidine in gastric ulcer patients. Scand J Gastroenterol 1979;14:175-176.Crossref 55. Machell RJ, Ciclitira PJ, Farthing MJG, et al: Cimetidine in the prevention of gastric ulcer relapse. Postgrad Med 1979;55:393-395.Crossref 56. McGuigan J: A consideration of the adverse effects of cimetidine. Gastroenterology 1981;80:181-189. 57. Elder JB, Ganguli PC, Gillespie IE: Cimetidine and gastric cancer. Lancet 1979;1:1005-1006.Crossref 58. Lewis JH, Woods M III: Gastric carcinoma in patients with unoperated duodenal ulcer disease. Am J Gastroenterol 1982;77:368-373. 59. Ashton MG, Holdsworth CD, Ryan FP, et al: Healing of gastric ulcers after 1, 2, and 3 months of ranitidine. Br Med J 1982;284:467-468.Crossref 60. Samloff IM: Pepsins, peptic activity, and peptic inhibitors. J Clin Gastroenterol 1981;3( (suppl 2) ):91-94.Crossref 61. Svendsen LB, Christiansen PM, Bonnevie O: Gastric ulcer therapy with a pepsin-inactivating peptide, pepstatin: A double-blind randomized clinical trial. Scand J Gastroenterol 1979;14:929-932. 62. Zimmon DS, Miller G, Cox G, et al: Specific inhibition of gastric pepsin in the treatment of gastric ulcer. Gastroenterology 1969;56:19-23. 63. Harrington SJ, Schlegel JF, Code CF: The protective effect of sucralfate on the gastric mucosa of rats. J Clin Gastroenterol 1981;3( (suppl 2) ):129-134.Crossref 64. Marks IN, Lucke W, Wright JP, et al: Ulcer healing and relapse rates after initial treatment with cimetidine or sucralfate. J Clin Gastroenterol 1981;3( (suppl 2) ):163-165. 65. Fixa B, Komarova O: Aluminum sucrose sulphate (sucralfate) in the treatment of peptic ulcer (double-blind study) , in Caspary WF (ed): Duodenal Ulcer, Gastric Ulcer, Sucralfate: A New Therapeutic Concept . Munich, Urban & Schwarzenberg, 1981, pp 80-84. 66. Orchard R, Elliot C: A double-blind placebo-controlled study of sucralfate in the treatment of gastric and duodenal ulcer , in Caspary WF (ed): Duodenal Ulcer, Gastric Ulcer, Sucralfate: A New Therapeutic Concept . Munich, Urban & Schwarzenberg, 1981, pp 85-88. 67. Ishimori A, Arakawa H: A placebo-controlled, double-blind trial using sucralfate for the treatment of peptic ulcer: A multicenter Japanese study , in Caspary WF (ed): Duodenal Ulcer, Gastric Ulcer, Sucralfate: A New Therapeutic Concept . Munich, Urban & Schwarzenberg, 1981, pp 93-100. 68. Rhodes J, Mayberry JF, Williams RA, et al: Clinical trial of sucralfate in the treatment of gastric ulcer , in Caspary WF (ed): Duodenal Ulcer, Gastric Ulcer, Sucralfate: A New Therapeutic Concept . Munich, Urban & Schwarzenberg, 1981, pp 101-104. 69. Penaloza-Rosas A: Treatment and endoscopic control of gastric ulcer, in Caspary WF (ed): Duodenal Ulcer, Gastric Ulcer, Sucralfate: A New Therapeutic Concept . Munich, Urban & Schwarzenberg, 1981, pp 105-110. 70. Lahtinen J, Ala-Kaila D, Aukee S, et al: Sucralfate and antacid in the treatment of gastric duodenal ulcer: The preliminary report of a multicenter double-blind trial , in Caspary WR (ed): Duodenal Ulcer, Gastric Ulcer, Sucralfate: A New Therapeutic Concept . Munich, Urban & Schwarzenberg, 1981, pp 111-115. 71. Richardson CT: New medical treatments, in Grossman MI (moderator): Peptic ulcer: New therapies, new diseases. Ann Intern Med 1981;95:618-620. 72. Wetterhus S, Aubert E, Berg CE, et al: The effect of trimipramine (Surmontil) on symptoms and healing of peptic ulcer: A double-blind study. Scand J Gastroenterol 1977;12( (suppl 43) ):33-38. 73. Morelli A, Pelli A, Norducci F, et al: Pirenzepine in the treatment of gastric ulcer: A double-blind short-term clinical trial. Scand J Gastroenterol 1979;12( (suppl 43) ):51-55. 74. Oselladore D, Chierichetti SM, Norberto L, et al: Pirenzepine (LS 519) in severe duodenal ulcer and in gastric ulcer: A double-blind clinical trial. Scand J Gastroenterol 1979;( (suppl 57) ):33-39. 75. Cerlek S, Papa B, Katicic M, et al: Pirenzepine in gastric and duodenal ulcer: A double-blind trial. J Int Med Res 1981;9:148-151. 76. Soll AH: Pharmacology of inhibitors of parietal cell function. J Clin Gastroenterol 1981;3( (suppl 2) ):85-90. 77. Allen A, Garner A: Mucous and bicarbonate secretion in the stomach and their possible role in mucosal protection. Gut 1980;21:249-262.Crossref 78. Kauffman GL: Drug therapy for peptic ulcer: Drugs that act on the gastric mucosa. J Clin Gastroenterol 1981;3( (suppl 2) ):95-101. 79. Nagashima R: Mechanisms of actions of sucralfate. J Clin Gastroenterol 1981;3( (suppl 2) ):117-127. 80. McHardy GG: A multicenter, double-blind trial of sucralfate and placebo in duodenal ulcer. J Clin Gastroenterol 1981;3( (suppl 2) ):147-152.Crossref 81. Hollander D: Efficacy of sucralfate for duodenal ulcers: A multicenter, double-blind trial. J Clin Gastroenterol 1981;3( (suppl 2) ):153-157.Crossref 82. Tester MA, Lim ES: Protection of gastric mucosa by sucralfate from aspirin-induced erosions. J Clin Gastroenterol 1981;3( (suppl 2) ): 175-179.Crossref 83. Miyake T, Ariyoshi J, Suzaki T, et al: Endoscopic evaluation of the effect of sucralfate therapy and other clinical parameters on the recurrence rate of gastric ulcers. Dig Dis Sci 1980;25:1-7.Crossref 84. Fisher RS. Sucralfate: A review of drug tolerance and safety. J Clin Gastroenterol 1981;3( (suppl 2) ):181-184. 85. Wilson TR: The pharmacology of tri-potassium di-citrato bismuthate (TDB). Postgrad Med J 1975;51( (suppl 5) ):18-21.Crossref 86. Koo J, Ho J, Lam SK, et al: Selective coating of gastric ulcer by tripotassium dicitrato bismuthate in the rat. Gastroenterology 1982;82:864-870. 87. Weiss G, Serfontein WJ: The efficiency of bismuth-protein-complex compound in the treatment of gastric and duodenal ulcers. S Afr Med J 1971;45:467-470. 88. Moshal MG: A double-blind gastroscopic study of a bismuth-peptic complex in gastric ulceration. S Afr Med J 1974;48:1610-1611. 89. Boyes BE, Woolf IL, Wilson RY, et al: Treatment of gastric ulceration with a bismuth preparation. Postgrad Med J 1975;51( (suppl 5) ):29-33. 90. Lee SP, Nicholson GI: Increased healing of gastric and duodenal ulcers in a controlled trial using tripotassium dicitrato-bismuthate. Med J Aust 1977;1:808-812. 91. Lam SK, Koo J, Cheng CH, et al: Treatment of corpus and prepyloric gastric ulcers with tripotassium dicitrato bismuthate (De-Nol), abstracted. Gastroenterology 1981;80:1202. 92. Tanner AR, Cowlishaw JL, Cowan AE, et al: Efficacy of cimetidine and tri-potassium di-citrato bismuthate (De-Nol) in chronic gastric ulceration: A comparative study. Med J Aust 1979;1:1-2. 93. La Brooy S, Taylor R, Hunt R, et al: Controlled comparison of cimetidine and carbenoxolone sodium in gastric ulcer. Br Med J 1979;1:1308-1309.Crossref 94. Geismar P, Mosbech J, Myren J: A double-blind study of the effect of carbenoxolone sodium in the treatment of gastric ulcer. Scand J Gastroenterol 1973;8:251-256. 95. Bank S, Marks I: Maintenance carbenoxolone in the prevention of gastric ulcer recurrence , in Baron J, Sullivan F (eds): Carbenoxolone Sodium . London, Butterworth Inc, 1970, pp 103-116. 96. Ganguli PC, Mohamed D: Long-term therapy with carbenoxolone in the prevention of recurrence of gastric ulcer: Natural history and evolution of important side-effects and measures to avoid them. Scand J Gastroenterol Suppl 1980;65:63-69. 97. Rhodes J, Bardardo DE, Phillips SF, et al: Increased reflux of bile into the stomach in patients with gastric ulcer. Gastroenterology 1969;57:241-252. 98. Ritchie WP Jr, Shearburn EW III: Influence of isoproterenol and cholestyratmine on acute gastric mucosal ulcerogenesis. Gastroenterology 1977;73:63-65. 99. Meshkinpour H, Elashoff J, Stewart H III, et al: Effect of cholestyramine on the symptoms of relux gastritis: A randomized, double-blind, crossover study. Gastroenterology 1977;73:441-443. 100. Black RB, Rhodes J, Tavies GT, et al: A controlled clinical trial of cholestyramine in the treatment of gastric ulcer. Gastroenterology 1971;61:821-825. 101. Robert A: Prostaglandins and the concept of cytoprotection, in Grossman MI (moderator): Peptic ulcer: New therapies, new diseases. Ann Intern Med 1981;95:616-618. 102. Fung WP, Karim SM, Tye CT: Effect of 15 (R) 15 methyl-prostaglandin E2 methyl ester on healing of gastric ulcers. Lancet 1974;2:10-12.Crossref 103. Robert A, Nezamis JE, Lancaster C, et al: Cytoprotection by prostaglandins in rats: Prevention of gastric necrosis produced by alcohol, HCl, NaOH, hypertonic NaCl and thermal injury. Gastroenterology 1979;77:433-443. 104. Cohen MM, Cheung G, Lyster DM: Prevention of aspirin-induced faecal blood loss by prostaglandin E2. Gut 1980;21:602-606.Crossref 105. Johansson C, Kollberg B, Nordemar R, et al: Protective effect of prostaglandin E2 in the gastrointestinal tract during indomethacin treatment of rheumatic diseases. Gastroenterology 1980;78:479-483. 106. Giannikopoulos I, Ringel P, Zai D, et al: Use of 15 (R)-15 methylprostaglandin E2 (15(R)-15 MePGE2) for the treatment of massive upper gastrointestinal bleeding in a critically ill patient, abstracted. Gastronintest Endose 1982;28:127. 107. Fung W-P, Karim SMM: Effect of 15 (R)-15-methyl prostaglandin E2 on the healing of gastric ulcers: Double-blind endoscopic study. Med J Aust 1976;2:127-128. 108. Gibinski K, Rybicka J, Mikos E, et al: Double-blind clinical trial on gastroduodenal ulcer healing with PGE2 analogues. Gut 1977;18:636-639.Crossref 109. Kollberg B, Nordemar R, Johansson C: Gastrointestinal protection by low-dose oral prostaglandin E2 in rheumatic diseases. Scand J Gastroenterol 1981;16:1005-1008.Crossref 110. Sun DCH, Stempien SJ: Site and size of the ulcer as determinants of outcome. The Veterans Administration Cooperative Study on Gastric Ulcer. Gastroenterology 1971;61:576-584. 111. Sakita T, Oguro Y, Takasu S, et al: Observations on the healing of ulcerations in early gastric cancer: The life cycle of the malignant ulcer. Gastroenterology 1971;60:835-844. 112. Bachrach WH: Observations upon the complete healing of neoplastic ulcerations of the stomach. Surg Gynecol Obstet 1962;114:69-82. 113. Piper DW, Shinners J, Creig M, et al: Effect of ulcer healing on the prognosis of chronic gastric ulcer. Gut 1978;19:419-424.Crossref 114. Hanscom DH, Buchman E: The follow-up period. The Veterans Administration Cooperative Study on Gastric Ulcer. Gastroenterology 1971;62:585-591. 115. Littman A, Hanscom DH: The course of recurrent ulcer. The Veterans Administration Cooperative Study on Gastric Ulcer. Gastroenterology 1971;61:592-597. 116. Loludice TA, Saleem T, Lang JA: Cimetidine in the treatment of gastric ulcer induced by steroidal and nonsteroidal anti-inflammatory agents. Am J Gastroenterol 1981;75:104-110. 117. Gerber LH, Rooney PG, McCarthy DM: Healing of peptic ulcers during continuing anti-inflammatory drug therapy in rheumatoid arthritis. J Clin Gastroenterol 1981;3:7-11.Crossref 118. Skillman JJ, Bushnell LS, Goldman H, et al: Respiratory failure, hypotension, sepsis, and jaundice: A clinical syndrome associated with lethal hemorrhage from acute stress ulceration of the stomach. Am J Surg 1969;117:523-530.Crossref 119. Hastings PR, Skillman JJ, Bushnell LS, et al: Antacid titration in the prevention of acute gastrintestinal bleeding, a controlled, randomized trial in 100 critically ill patients. N Engl J Med 1978;298:1041-1045.Crossref 120. Priebe HJ, Skillman JJ, Bushnell LS, et al: Antacid versus cimetidine in preventing acute gastrointestinal bleeding: A randomized trial in 75 critically ill patients. N Engl J Med 1980;302:426-430.Crossref 121. Stabile BE, Passaro E Jr: Recurrent peptic ulcer. Gastroenterology 1976;70:124-135. 122. Boyle JD: Multiple gastric ulcers. The Veterans Administration Cooperative Study on Gastric Ulcer. Gastroenterology 1971;61:628-631. 123. Baume PE, Hunt JH: Failure of potent antacid therapy to hasten healing in chronic gastric ulcers. Aust Ann Med 1969;18:113-116. 124. Butler ML, Gersh H: Antacid vs placebo in hospitalized gastric ulcer patients: A controlled therapeutic study. Am J Dig Dis 1975;20:803-807.Crossref 125. Littman A, Welch R, Fruin RC, et al: Controlled trial of aluminum hydroxide gels for peptic ulcer. Gastroenterology 1977;73:6-10. 126. Ciclitira PJ, Machell RJ, Farthing MJG, et al: Double-blind controlled trial of cimetidine in the healing of gastric ulcer. Gut 1977;20:730-734.Crossref 127. Frost F, Rahbek I, Rune SJ, et al: Cimetidine in patients with gastric ulcer: A multicentre controlled trial. Br Med J 1977;2:795-797.Crossref 128. Machell RJ, Ciclitira PC, Farthing M, et al: Cimetidine and gastric ulcer healing. Br Med J 1977;2:1023.Crossref 129. Landecker KD, Hunt JH, Gillespie P, et al, cited in Freston JW: Cimetidine in the treatment of gastric ulcer: Review and commentary. Gastroenterology 1978;74:426-430. 130. Dyck WP, Belsito A, Bertran F, et al: Cimetidine, antacid, and hospitalization in the treatment of benign gastric ulcer: A multicenter double-blind study. Gastroenterology 1978;74:410-415. 131. Englert E, Freston JW, Graham DY, et al: Cimetidine, antacid and hospitalization in the treatment of benign gastric ulcer: A multicenter double-blind study. Gastroenterology 1978;74:416-425. 132. Schwamberger K, Reissigl H: Carbenoxolone patients and gastric ulcer: A double-blind trial. Scand J Gastroenterol Suppl 1980;65:59-62. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Treatment of Gastric Ulcer: What Is Old and What Is New

Archives of Internal Medicine , Volume 143 (2) – Feb 1, 1983

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American Medical Association
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Copyright © 1983 American Medical Association. All Rights Reserved.
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0003-9926
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1538-3679
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Abstract

Abstract • The rational treatment of gastric ulcer (GU) requires both an understanding of the various causative factors responsible for what is best considered a spectrum of disorders, as well as a familiarity with the newer antisecretory and cytoprotective therapies that are available. Gastric ulcers that fulfill the criteria to be peptic ulcers (ie, occur in the antrum in the presence of excess luminal acid, with or without a coexisting duodenal ulcer) are best treated with a histamine H2-receptor antagonist. For GUs that develop in the setting of normal or reduced acid output, or those that occur as a result of direct (ie, drug-induced or bile acid-related) mucosal injury, use of a cytoprotective agent (eg, sucralfate) is the treatment of choice. Any GU that falls to heal within 12 to 15 weeks should be carefully examined to exclude the presence of a malignant neoplasm and should be considered for surgical resection. (Arch Intern Med 1983;143:264-274) References 1. Kirsner JB, Clayman CB, Palmer WL: The problem of gastric ulcer. Arch Intern Med 1959;104:995-1015.Crossref 2. Kurata JH: Time trends, in Grossman MI (moderator): Peptic ulcer: New therapies, new diseases. Ann Intern Med 1981;95:609-610.Crossref 3. Richardson CT: Gastric ulcer , in Sleisenger MH, Fortran JS (eds): Gastrointestinal Disease , ed 2. Philadelphia, WB Saunders Co, 1978, chap 51. 4. Isenberg JI: Peptic ulcer. DM , (December) 1981, pp 1-58. 5. Watkinson G: The incidence of chronic peptic ulcer found at necropsy. Gut 1960;1:14-18.Crossref 6. Kirk RM: Are gastric and duodenal ulcers separate diseases or do they form a continuum?, in Ginsberg AL (ed): The ulcer controversy. Dig Dis Sci 1981;26:149-154.Crossref 7. Grossman MI: Peptic Ulcer: A Guide for the Practicing Physician . Chicago, Year Book Medical Publishers, 1981. 8. Gillies M, Skyring A: Gastric ulcer, duodenal ulcer and gastric carcinoma: A case-control study of certain social and environmental factors. Med J Aust 1968;2:1132-1136. 9. Piper DW, McIntosh JH, Ariotti DE, et al: Analgesic ingestion and chronic peptic ulcer. Gastroenterology 1981;80:427-432. 10. Cameron AJ: Aspirin and gastric ulcer. Mayo Clin Proc 1975;50:565-570. 11. Silvoso GR, Ivey KJ, Butt JH, et al: Incidence of gastric lesions in patients with rheumatic disease on chronic aspirin therapy. Ann Intern Med 1979;92:517-520.Crossref 12. Cooke AR: The role of the mucosal barrier in drug-induced gastric ulceration and erosion. Dig Dis Sci 1976;21:155-164.Crossref 13. Porter LE: The gastrointestinal tract, in: Van Thiel DH (moderator): Gastrointestinal and hepatic manifestations of chronic alcoholism. Gastroenterology 1981;81:596-599. 14. Lanza FL, Royer GL, Nelson RS, et al: The effects of ibuprofen, indomethacin, aspirin, naproxen, and placebo on the gastric mucosa of normal volunteers: A gastroscopic and photographic study. Dig Dis Sci 1979;24:823-828.Crossref 15. Schwartz K: Ueber penetrierende magen und jejunalgeschwure. Beitr Klin Chir 1910;67:96-128. 16. Sogge MR, Butler ML: Reassessment of the management of benign gastric ulcer with achlorhydria. J Clin Gastroenterol 1981;3:13-15.Crossref 17. Rovelstad RA: The incompetent pyloric sphincter: Bile and mucosal ulcerations. Dig Dis Sci 1976;21:165-172.Crossref 18. Davenport HW: Damage to the gastric mucosa: Effects of salicylates and stimulation. Gastroenterology 1965;49:189-196. 19. Kivilaakso E, Silen W: Pathogenesis of experimental gastric-mucosal injury. N Engl J Med 1979;301:364-369.Crossref 20. Chung RSK, Field M, Silen W: Effects of methylprednisolone on hydrogen ion absorption in the canine stomach. J Clin Invest 1978;62:262-270.Crossref 21. Meyer JH: Altered gastric motility, in Grossman MI (moderator): Peptic ulcer: New therapies, new diseases. Ann Intern Med 1981;95:615-616.Crossref 22. Davidson ED, Hersh T: Bile reflux gastritis: Contribution of inadequate gastric emptying. Am J Surg 1975;130:514-518.Crossref 23. Moody FG, Cheung LY, Simons MA, et al: Stress and the acute gastric mucosal lesion. Dig Dis Sci 1976;21:148-154.Crossref 24. Czaja AJ, McAlhany JC, Pruitt BA Jr: Acute gastroduodenal disease after thermal injury: An endoscopic evaluation of incidence and natural history. N Engl J Med 1974;291:925-929.Crossref 25. Laufer I: Introduction, Double Contrast Gastrointestinal Radiology With Endoscopic Correlation . Philadelphia, WB Saunders Co, 1979, pp 1-9. 26. Wenger J, Brandborg LL, Spellman FA: Cancer: I. Clinical aspects. The Veterans Administration Cooperative Study on Gastric Ulcer. Gastroenterology 1971;61:598-605. 27. Dekker W, Tytgat GN: Diagnostic accuracy of fiber-endoscopy in the detection of upper intestinal malignancy: A follow-up analysis. Gastroenterology 1977;73:710-714. 28. Graham DY, Schwartz JT, Cain D, et al: Prospective evaluation of biopsy number in the diagnosis of esophageal and gastric carcinoma. 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Journal

Archives of Internal MedicineAmerican Medical Association

Published: Feb 1, 1983

References