PEPTIC ULCER

peptic ulcer
peptic ulcer
peptic ulcer
peptic ulcer

DESCRIPTION

Ulcer in the stomach mucosa (gastric ulcer: GU) or first few centimetres of the duodenum (duodenal ulcer: DU), which penetrates into or through the muscularis mucosa.

Diagnosis is made after investigation, preferably by endoscopy, as all Gus require 4-quadrant biopsy to exclude malignancy.

GUs and complicated DUs, those that have bled, perforated or are recurrent, must be rescoped until the ulcer has healed. H. pylori can be assessed at scope by rapid urease testing (RUT) or biopsy.

GENERAL MEASURES

Advise patient to avoid ulcerogenic medications, e.g. NSAIDs.

Advise patient to stop smoking and drinking alcohol.

Dietary advice by dietician.

MEDICINE TREATMENT

  1. pylori +ve

The vast majority of GUs and DUs are associated with H. pylori infection and eradication therapy is indicated if infection is present. This will greatly reduce the rate of recurrent ulceration. Empiric eradication of H. pylori is not recommended.

Proton pump inhibitor (PPI):

• Omeprazole, oral, 40 mg daily.

o Duodenal ulcer: for 7 days.

o Gastric ulcer: for 28 days.

AND

  1. pylori eradication:

• Amoxicillin, oral, 1 g 12 hourly.

OR

For penicillin allergy:

• Clarithromycin, oral, 500 mg 12 hourly.

PLUS

• Metronidazole, oral, 400 mg 12 hourly for 7 days.

Failure of H. pylori eradication (best dealt with in a specialist setting):

• Clarithromycin, oral, 500 mg 12 hourly.

PLUS

• Amoxicillin, oral, 1 g 12 hourly for 7 days.

If resistant to this, refer.

  1. pylori –ve

These are usually a consequence of NSAID use.

Stop NSAID until ulcer has healed.

If patient is unable to stop NSAID, refer to specialist.

Proton pump inhibitor (PPI):

See also  MICROBIOLOGICAL TESTING

• Omeprazole, oral, 40 mg daily.

o Duodenal ulcer: for 7–14 days.

o Gastric ulcer: for 28 days.

Resistant disease

Ulcer not healing.

High-risk patients, i.e. poor surgical risk and the elderly or concomitant disease. Maintenance therapy with PPI, e.g.:

• Omeprazole, oral, 20 mg daily. Specialist initiated.

 

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