Neutralize Acid Secretion

Neutralize acid secretion The options available are: - antacids: for example the aluminum hydroxide/magnesium hydroxide combination (we combine these two molecules because the first is a source of constipation, the second a source of diarrhea). This combination is contraindicated in cases of renal insufficiency; - H2 receptor antagonists: cimetidine (but possible anti-androgenic effects: gynecomastia) or, more effective: ranitidine, famotidine, nizatidine; - proton pump inhibitors (PPI): these are the most effective in neutralizing gastric acid secretion: omeprazole, pantoprazole, etc. Gastric carcinoid tumors have been attributed to PPIs in animals, but never in humans. Protect the mucous membrane -The cytoprotectors are: - sucralfate: contraindicated in people with renal insufficiency, it can be a source of constipation; - bismuth-based compounds: they can cause constipation and color the stools (and tongue) black; prostaglandin analogues (misoprostol): - possible cause of diarrhea, they are contraindicated in situations of potential pregnancy; - anticholinergics: they are almost completely abandoned in this indication. Eradicate Helicobacter pylori -When present (which is very often the case), the bacteria must be eradicated: ulcer recurrences in this case are only 10 to 20%, while ulcer recurrence reaches on average 60% of patients retaining Helicobacter pylori. The treatment should last 14 days (a 10 day treatment is not as effective), and may be: - triple therapy: bismuth salicylate + metronidazole + tetracycline (set available under the name Helidac), or omeprazole + clarithromycin + metronidazole (set available under the name Prevpac);

- quadruple therapy: omeprazole + bismuth salicylate + metronidazole + tetracycline. To behave - Generally speaking (Helicobacter pylori positive patient), treatment is triple therapy for 14 days, followed by PPI for 4 to 6 weeks. Refractory forms (i.e. not cured after 12 weeks of treatment if UG, 8 weeks if UD) or complicated forms (hemorrhage for example) must have a surgical option proposed. In all cases, the patient must stop taking aspirin or non-steroidal anti- inflammatory drugs, and reduce their consumption of alcohol and tobacco.