Last updated: 11/24/2009

As of 2003, antrectomy is no longer the first line of treatment for either peptic ulcer disease or GAVE. It is usually reserved for patients with recurrent bleeding or other conditions such as malignancy, perforation, or obstruction.

Although...

surgery, including antrectomy, is the most common treatment for stomach cancer, it is almost always necessary to combine it with chemotherapy, radiation treatment, or biological therapy (immunotherapy). The reason for a combination of treatments is that stomach cancer is rarely discovered early. Its first symptoms are often mild and easily mistaken for the symptoms of heartburn or a stomach virus. As a result, the cancer has often spread beyond the stomach by the time it is diagnosed.

Medication

Treatment of peptic ulcers caused by H. pylori has changed its focus in recent years from lowering the level of acidity in the stomach to eradicating the bacterium. Since no single antibiotic is effective in curing H. pylori infections, so-called triple therapy typically consists of a combination of one or two antibiotics to kill the bacterium plus a medication to lower acid production and a third medication (usually bismuth subsalicylate) to protect the stomach lining.

Specific types of medications that are used as part of triple therapy or for relief of discomfort include:

• H₂ blockers. These are used together with antibiotics in triple therapy to reduce stomach acid secretion. H₂ blockers include cimetidine, ranitidine, famotidine, and nizatidine. Some are available as over-the-counter (OTC) medications.
• Proton pump inhibitors. These medications include drugs such as omeprazole and lansoprazole. They are given to suppress production of stomach acid.
• Prostaglandins. These are given to treat ulcers produced by a group of pain medications known as NSAIDs. Prostaglandins protect the stomach lining as well as lower acid secretion. The best-known medication in this category is misoprostol.
• Sucralfate. Sucralfate is a compound of sucrose and aluminum that covers ulcers with a protective coating that allows eroded tissues to heal.
• Antacids. These compounds are available as OTC tablets or liquids.
• Bismuth subsalicylate. Sold as an OTC under the trade name Pepto-Bismol, this medication has some antibacterial effectiveness against H. pylori as well as protecting the stomach lining.

Endoscopy

Endoscopy can be used for treatment as well as diagnosis. About 10 different methods are in use as of 2003 for treating bleeding ulcers and AVMs with the help of an endoscope; the most common involve the injection of epinephrine or a sclerosing solution; the application of a thermal probe to the bleeding area; or the use of a Nd:YAG laser to coagulate the open blood vessels. Watermelon stomach is now treated more often with argon plasma coagulation than with an antrectomy. Recurrent bleeding, however, occurs in 15–20% of ulcers treated with endoscopic methods.

Complementary and alternative (CAM) approaches

Complementary and alternative approaches that have been used to treat gastric ulcers related to PUD include acupuncture, Ayurvedic medicine, and herbal preparations. Ayurvedic medicine, which is the traditional medical system of India, classifies people according to metabolic body type. People who belong to the type known as pitta are considered particularly prone to ulcers and treated with a diet that emphasizes "cooling" foods, including large quantities of vegetables. In Japanese medicine, ulcer remedies made from licorice or bupleurum are frequently prescribed. Western herbalists recommend preparations containing fennel, fenugreek, slippery elm, or marshmallow root in addition to licorice to relieve the pain of stomach ulcers.