Medical management of gastric ulcer

The aetiopathogenesis of gastric ulceration suggests that though gastric acid plays an essential role, damage to the gastric mucosal barrier may be of more importance. Gastric ulceration is a complex disease and certain factors such as the size and site of the ulceration may influence healing. If these are not carefully standardised assessment of various therapeutic agents may produce conflicting results. The factor which has perhaps most influenced the approach to therapy of gastric ulcers is the difficulty in differentiating benign from malignant ulceration. The first accepted form of treatment for gastric ulceration was carbenoxolone sodium and though a high incidence of side effects were reported with its use, it enabled treatment on an outpatient basis. More recently the histamine H2-receptor antagonists have been shown to be equally effective and minimal reported adverse effects have made them the treatment of choice. Newer drugs are available but are yet to be fully evaluated. At present maintenance therapy is not advisable in patients with gastric ulceration unless the risk of relapse in these patients outweighs the danger of delaying diagnosis of malignancy. Where maintenance therapy is used patients should be closely monitored clinically and endoscopically.