Approximately one-third of the population in Western societies experiences regular dyspepsia, although more than half self-medicate with over-the-counter antacid preparations and do not seek medical advice. Up to 50% of those who do will have demonstrable pathology, most commonly gastro-oesophageal reflux or peptic ulceration. The remainder, in whom no abnormality is found, are diagnosed as having nonulcer dyspepsia,The pathophysiology and treatment differ for each of these three conditions. Drugs for peptic ulcer
• Neutralisation of secreted acid
• Reduction of acid secretion
• Enhancing mucosal resistance
• Eradication of He/icobacter pylori
• NSAIDs and the stomach
Gastro-oesophageal reflux and vomiting
• Antiemesis and prokinetic drugs
• Treatment of various forms of vomiting
Peptic ulcer occurs when there is an imbalance between the damaging effects of gastric acid and pepsin, and the defence mechanisms, which protect the gastric and duodenal mucosa from these substances (Fig. 31.1). The exact mechanisms are still poorly understood. A major cause of peptic ulcer is use of nonsteroidal anti-inflammatory drugs (NSAIDs), particularly in the elderly.
Treatment of peptic ulceration has traditionally centred around measures to neutralise gastric acid, to inhibit its secretion, or to enhance mucosal defences. More recently, recognition of the central role of Helicobacter pylori has revolutionised treatment. Smoking is a major environmental factor and patients who smoke should be advised to stop.
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