|Clinical Guidelines and Treatment Manual (Médecins Sans Frontières, 1993)|
|Chapter 3 - Gastro-intestinal diseases|
Inflammatory or ulcerative lesions of the gastro-duodenal mucosae.
- 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.
- 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.
- 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.