Antiulcer Therapy

Abstract

Perhaps older drugs to treat ulcers, such as antacids, are just as effective as the newer drugs, but veterinarians have all but abandoned these drugs in favor of H2-receptor antagonists, sucralfate, and omeprazole. For most patients, one of the H2-receptor antagonists or sucralfate is probably the initial drug of choice. For patients refractory to these drugs or for which once-a-day dosing is desirable, omeprazole has an advantage. The doses for these drugs are listed in Table 1. Patients presented with acute bleeding ulcers should be managed with emergency therapy. Fluid therapy and blood transfusions are the essential elements of the initial therapy. Surgical resection of the ulcers may be necessary, and most patients should be administered H2-receptor antagonists or sucralfate while they recuperate. Longer term therapy with antiulcer drugs will depend on the predisposing factors that initiated the ulcers. The practice of lavage of the stomach with iced saline or epinephrine to stop bleeding from gastric ulcers is not effective. A common cause of ulcers in small animals is the administration of NSAIDs. Ulcers caused by these agents should be managed like any other ulcers. Fortunately, if ulcers are diagnosed early, they usually heal once the NSAID is discontinued. Unfortunately, many NSAID-induced ulcers identified postmortem did not produce clinical signs, and the ulcers may not be apparent until severe bleeding occurs. In cases in which patients are at risk for developing ulcers from NSAIDs, there may be an advantage in administering the synthetic prostaglandin misoprostol. In many patients that are sensitive to the GI irritation of NSAIDs, switching from one NSAID to another may alleviate some of the signs. Buffered aspirin may be somewhat less irritating than plain uncoated aspirin but will not completely prevent ulcers. The administration of enteric-coated aspirin tablets to dogs is discouraged, because systemic absorption from these tablets is unpredictable.