Gastritis and Peptic Ulcer Disease: Diagnosis and Treatment
- 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
- X–rays may also be used, but these are less accurate than endoscopy.
- 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
- 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
- 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
- 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.