Gastritis and Peptic Ulcer Disease: Diagnosis and Treatment

Diagnosis

• The evaluation begins with a medical history and a physical examination.
  
• Blood testing may be helpful, especially if anemia is suspected.
  
• The best test to diagnose gastritis and ulcers is endoscopy of the stomach. In this test, a thin tube with a camera on its end is slowly advanced through the mouth and throat and into the stomach. It allows for direct visualization of the stomach lining and for biopsy to evaluate for H. pylori infection and rule out cancer.
  
• X–rays may also be used, but these are less accurate than endoscopy.
  

Treatment

• Factors that increase risk should be avoided. These include tobacco use, alcohol, nonsteroidal anti–inflammatory medications (e.g., ibuprofen), aspirin, and steroids.
• Antacid therapy to reduce acid production is the most common treatment. There are several types of antacids, including over–the–counter antacid medications (e.g., Maalox, Mylanta, Rolaids, and Tums), histamine–2 (H2) receptor blockers (e.g., cimetidine and ranitidine), and proton pump inhibitors (e.g., omeprazole).
• It is important to treat H. pylori infection, if present. Removal of H. pylori decreases the risk of recurrence from 50 to 80 percent to less than 10 percent, and also reduces the likelihood of complications, such as bleeding. Several antibiotic medications are available (e.g., clarithromycin, amoxicillin, metronidazole, and tetracycline). Most cases are treated with a combination of two or three antibiotics to ensure that H. pylori are eliminated.
• Surgery may be necessary for severe cases.
• Psychological distress should be addressed to ensure successful treatment. Compared with healthy people, patients with ulcers are particularly likely to respond to stress by producing more stomach acid, as much as 10 to 20 times the normal levels. Depression, anxiety, and ongoing stressful life circumstances have been shown to decrease ulcer healing, whereas psychologically stable individuals who develop an ulcer during a stressful period tend to remain free of symptoms after treatment.
• Exercise may decrease the risk for gastritis and ulcer disease. Exercise reduces acid secretion, and some evidence suggests it significantly decreases the risk for ulcer and for severe bleeding in persons with ulcers.