Peptic Ulcer Gastritis

Peptic ulcer disease and gastritis are among the commonest reasons an adult ends up in a gastroenterology clinic. For most of the twentieth century they meant restricted diets, antacids and, too often, surgery. Two discoveries changed that: the recognition of Helicobacter pylori as the main cause, and the arrival of proton pump inhibitors (PPIs). This article looks at the subject from both sides, the clinical picture the doctor meets at the bedside and the pharmacology behind each drug that gets chosen. It covers pathogenesis and the types of gastritis, the mechanism, dosing and adverse effects of the main drug groups, current eradication regimens in the light of rising clarithromycin resistance (with data from Central Asia), and a practical way of choosing the drug of choice in different clinical situations. Numbers in square brackets refer to the reference list at the end.