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Dx Gastritis Treatment:

Gastritis/ Gastric Ulcer

The Merck Manual Home Edition
"Gastritis is inflammation of the stomach lining. The stomach lining resists irritation and can usually withstand very strong acid. Nevertheless, in gastritis, the stomach lining becomes irritated and inflamed.

*The inflammation can be caused by many factors, including infection, injury, certain drugs, and disorders of the immune system. The most common cause is the Helicobacter pylori. There is a laboratory test that can be ordered On-Line to determine if a person has Helicobacter pylori. When symptoms do occur, they include abdominal pain or discomfort and sometimes nausea or vomiting.
*Doctors often base the diagnosis on the person's symptoms, but sometime they need to examine the stomach by using a flexible viewing tube (endoscopy).
*Treatment is with drugs that reduce stomach acid.

*Helicobacter pylori is present in 75% or more of persons with gastric ulcers.
Infection with Helicobacter pylori, a type of bacteria, is the most common cause of gastritis and peptic ulcer worldwide. Infection is very common and increases with age; by age 60, about 50% of people are infected. Long-term infection increases the risk of stomach cancer.

H. pylori contributes to ulcer formation by increasing acid production, interfering with the normal defenses against stomach acid, and producing toxins. Most people with gastritis from H. pylori infection do not develop symptoms, but people who do develop symptoms experience those typical of gastritis, such as indigestion and pain or discomfort in the upper abdomen. Ulcers caused by H. pylori infection produce symptoms similar to ulcers caused by other disorders, including pain in the upper abdomen.

H. pylori can be detected with tests that use blood, breath, or stool samples. However, because blood tests can remain positive for years after the H. pylori infection has been eliminated, the breath test is often used to confirm treatment success.
The likelihood that a peptic ulcer will recur during the course of 1 year is about 60 to 80% in people who have not been treated with antibiotics. This percentage decreases to less than 20% in people who have been treated with antibiotics. In addition, treatment of H. pylori infection may heal ulcers that have resisted previous treatment.

Gastritis usually causes no symptoms. When symptoms do occur, they vary depending on the cause and may include pain or discomfort (dyspepsia) or nausea or vomiting, problems that are often simply referred to as indigestion. Gastritis can lead to ulcers, which may cause the symptoms to get worse.
Ulcers can develop with several types of gastritis, especially acute stress gastritis, erosive gastritis, and radiation gastritis. Ulcers may bleed, causing a person to vomit blood (hematemesis) or pass tarry black stools (melena)... If an ulcer goes through (perforates) the stomach wall, stomach contents may spill into the abdominal cavity, resulting in inflammation and usually infection of the lining of the abdominal cavity (peritonitis) and sudden worsening of pain. Doctors may prescribe sucralfate, which helps to prevent irritation. When gastritis leads to ulceration that perforates the stomach wall, immediate surgery is usually needed.
Most people with acute stress gastritis recover fully when the underlying illness, injury, or bleeding is controlled. However, 2% of people in intensive care units have heavy bleeding from acute stress gastritis, which is often fatal. Therefore, doctors try to prevent acute stress gastritis after a major illness, major injury, or severe burn. Drugs that reduce acid production are commonly given after surgery and to people in most intensive care units to prevent acute stress gastritis. These drugs are also used to treat any ulcers that form. For people with heavy bleeding from acute stress gastritis, a wide variety of treatments have been used. Few of these treatments, however, improve the outcome. If bleeding continues, the entire stomach may have to be removed as a lifesaving measure. There is no cure for postgastrectomy gastritis or atrophic gastritis. People with anemia resulting from decreased absorption of vitamin B12 that occurs with atrophic gastritis must take supplemental injections of the B12 vitamin for the rest of their lives."

Medications Used in Treatment:
1. Proton Pump Inhibitors: Prilosec®/omeprazole, Prevacid®/lansoprazole, Nexium®/esomeprazole, Dexilant®/dexlansoprazole, Aciphex®/rabeprazole dr, Zegerid®/omeprazole-sodium bicarbonate, Axid®/nitatidine, esomeprazole strontium
2. Histamine-2 Anatagonists: Zantac®/famotidine, Tagamet®/cimetidine
3. Aluminum Complexes: Carafate®/sucralfate
4. Dopamine Receptor Antagonists: Reglan®/metoclopramide
5. Prostaglandins: Cytotec®/misoprostol

[Merck continued] Treatment
Proton pump inhibitors are prescribed when the strongest treatment is needed. H. pylori infection must be treated with antibiotics. The most popular treatment for H. pylori infection includes a proton pump inhibitor to reduce acid production combined with two antibiotics, such as amoxicillin 500mg and clarithromycin 500mg ER given twice daily for 7 to 14 days. The combination of bismuth subsalicylate(a drug similar to sucralfate), tetracycline (an antibiotic), metronidazole(an antibiotic), and a proton pump inhibitor (portonix 40mg) daily is another popular option. However, this treatment requires people to take a total of four drugs up to 4 times a day for 7 to preferrably 14 days
*[Editor]: but is hundreds of dollars less expensive] than combination preparations.

*[Editor] When the acute H. pylori infection has cleared and there is no evidence of ulcer, consider the natural treatments for gastro-esophageal reflux disease (G.E.R.D.) that include Betaine HCl (to close the esophagus to reflux) and digestive enzymes (to digest the food). Long-term use of drug therapy that opens the egress from the stomach can become the cause of long-term digestive problems.

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