CURRENT MANAGEMENT STRATEGIES IN ACID-RELATED DISORDERS

Authors
Citation
Sj. Rune et P. Bytzer, CURRENT MANAGEMENT STRATEGIES IN ACID-RELATED DISORDERS, The Yale journal of biology & medicine, 70(1), 1997, pp. 19-25
Citations number
35
Language
INGLESE
art.tipo
Article
ISSN journal
0044-0086
Volume
70
Issue
1
Year of publication
1997
Pages
19 - 25
Database
ISI
SICI code
0044-0086(1997)70:1<19:CMSIAD>2.0.ZU;2-3
Abstract
Acid-related disorders include not only reflux esophagitis and peptic ulcer, but also a subset of patients with endoscopy-negative dyspepsia . The management strategy differs between these diseases and therefore a precise diagnosis is important. The unaided clinical diagnosis is o f limited value in patients with pain or discomfort in the upper abdom en, and endoscopy is therefore an important and cost-effective diagnos tic tool. Duodenal ulcer is caused by an interplay between gastric aci d and Helicobacter pylori. The treatment is aimed at rapid symptom rel ief and healing and at the same time eradication of H. pylori. At pres ent the best choice is the combination of a proton pump inhibitor and two effective antimicrobial drugs, e.g., clarithromycin and metronidaz ole. The proton pump inhibitor has dual effect in this combination it provides optimal symptom relief and healing, and it increases the anti -ti. pylori-effect of the antimicrobial drugs. The risk of reinfection varies geographically; in Europe it is around 1 percent per year, and cure of the infection provides long-term, maybe life-long, cure of th e ulcer disease. Some gastric ulcers are not H. pylori related and the treatment strategy therefore includes a diagnostic test for this infe ction. If positive, treatment is similar to that in duodenal ulcer, wh ile H. pylori-negative gastric ulcer patients are treated with antisec retory drugs alone. Reflux esophagitis correlates with the degree of a cid exposure to the esophagus, and intensive acid inhibition is the mo st effective non-surgical therapy. In most cases the disease is chroni c and needs continuous long-term therapy to prevent relapse. A staged reduction in dosage of the acid inhibitory drug may be attempted when the esophagitis is healed and the patient has become symptom free, but full dose therapy is often needed. Patients with endoscopy-negative d yspepsia are a heterogenous group and a more precise identification of the cause of the symptoms is a prerequisite for rational treatment. E mpiric treatment can be tried in patients without alarm symptoms like bleeding or a palpable abdominal mass, and often an acid inhibitory dr ug is used. A more precise identification of those patients who have a cid-related symptoms is possible using placebo controlled single-subje ct trials with an effective acid inhibitory drug, but in daily routine these drugs are simply given for a short period of time, and in case symptomatic relief is observed, the symptoms may be regarded as being acid-related and treated accordingly.