TREATMENT OF ULCERS: DRUGS PREVENTING ACID FORMATION

Posted on December 9, 2009, under Gastrointestinal.

Q. What is the most widely used form of treatment at present?

A. Just now, probably the most popular form of therapy is the use of a family of drugs called the histamine IT receptor antagonists. The most widely used one is called cimetidine, although the doctor will probably give you a prescription using the trade name, ‘Tagamet’. These are tablets taken orally which act on the acid producing cells of the stomach wall, and prevent acid production. In turn, this inhibits the production of the other important stomach chemical, pepsin. Therefore, with no acid and pepsin present, the cause of the ulcer vanishes, and symptoms vanish as the ulcer gradually heals.

Q. How long does it take for symptoms to disappear?

A. Many patients report that symptoms, especially abdominal pain, disappear within a few days! This seems remarkable, especially with those in whom pain had been intermittently present for months or even years. It may be dramatic.

Q. Does cessation of pain mean the ulcer has healed completely?

A. Certainly not. It means acid production is stemmed, and the pain from acid irritation on the exposed nerves has stopped. It takes at least from four to six weeks for the stomach lining to grow over the ulcer site.

Unfortunately, many patients thinking that pain cessation means ulcer healing, foolishly stop medication. The results are then bad, for often within a few more days, the pain naturally recommences as acid production starts up again. Once the physician has ordered a course of treatment it is imperative that it be taken exactly as prescribed, and for the total number of tablets.

Q. What is the usual dosage?

A. Generally, 400 mg is taken morning and night. Many doctors now find that one single evening dose of 800 mg is preferable. It is easier to remember, and seems to give very satisfactory results. The aim is to keep acid at a low level during the day, and the higher bedtime dose is aimed at keeping it low throughout the night. Remember, nocturnal pain due to acid build up is the hallmark of the ulcer patient — and a very disturbing symptom. This dosage method is different to multiple doses which were originally recommended.

Q. What is the value of this altered dose routine?

A. First of all, doctors have found that the results are often as good or better with this system. Also, by making the tablet swallowing routine less frequent, a strange phenomenon called ‘patient compliance’ is far higher.

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