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close this bookClinical Guidelines and Treatment Manual (Médecins Sans Frontières, 1993)
close this folderChapter 3 - Gastro-intestinal diseases
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View the documentStomatitis
View the documentGastritis and Peptic Ulcer
View the documentAcute diarrhoea

Gastritis and Peptic Ulcer

Inflammatory or ulcerative lesions of the gastro-duodenal mucosae.

Clinical features

- Epigastric burning pain, sometimes made worse and sometimes relieved by food (especially milk) but recurring about two hours after meals.

- Acid regurgitation, nausea.

- Abdomen soft and non-tender (unless perforation).

- Exclude parasitosis (strongyloides): stool examination.

Treatmert (dispensary)

- Diet: avoid spices, alcohol, tobacco, carbonated drinks.
Encourage regular meals, dairy products.

- Antacids: aluminium hidroxide (PO): 300 to 500 mg in a single dose, taken 1 hour after each meal or during attacks of pain

- Reassure the patient: anxiety may be a causative factor. If needed: diazepam (PO): 15 mg/d divided in 3 doses for a brief period (5-10 days)

- If severe pain continues, exclude perforation: examine abdomen for peritonism, PR exam for rectal blood (melena on glove), keep under observation, surgical referral if necessary.
Give: atropine (IM or SC): 1 mg stat.

(hospital)

- If hemorrhage:
· establish IV line,
· give plasma volume expander (Haemacel...),
· nasogastric tube: to observe if hemorrage continues,
· transfuse if possible and refer to a surgical unit.

NB: acetylsalicylic acid and other non-steroidal anti-inflammatories are contraindicated in patients with a history of peptic ulcer.