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    Management of Peptic Ulcer Disease

    Uploaded by

    Joan Luis
    This document outlines treatment guidelines for peptic ulcer disease. It discusses treating H. pylori infections with triple therapy antibiotics for 14 days. For ulcers not caused by H. pylori, it recommends proton pump inhibitors or H2 blockers. Surgery is an option for cases that do not respond to medication or develop complications. Lifestyle changes like quitting smoking and reducing stress can help prevent ulcers.

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    Management of Peptic Ulcer Disease

    Uploaded by

    Joan Luis
    35 views9 pages
    This document outlines treatment guidelines for peptic ulcer disease. It discusses treating H. pylori infections with triple therapy antibiotics for 14 days. For ulcers not caused by H. pylori, it recommends proton pump inhibitors or H2 blockers. Surgery is an option for cases that do not respond to medication or develop complications. Lifestyle changes like quitting smoking and reducing stress can help prevent ulcers.

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    This document outlines treatment guidelines for peptic ulcer disease. It discusses treating H. pylori infections with triple therapy antibiotics for 14 days. For ulcers not caused by H. pylori, it recommends proton pump inhibitors or H2 blockers. Surgery is an option for cases that do not respond to medication or develop complications. Lifestyle changes like quitting smoking and reducing stress can help prevent ulcers.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    35 views9 pages

    Management of Peptic Ulcer Disease

    Uploaded by

    Joan Luis
    This document outlines treatment guidelines for peptic ulcer disease. It discusses treating H. pylori infections with triple therapy antibiotics for 14 days. For ulcers not caused by H. pylori, it recommends proton pump inhibitors or H2 blockers. Surgery is an option for cases that do not respond to medication or develop complications. Lifestyle changes like quitting smoking and reducing stress can help prevent ulcers.

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    © All Rights Reserved
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    Download as ppt, pdf, or txt
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    Management of Peptic

    Ulcer Disease
    Treatment Plan: H. Pylori

    Eradication Therapy: Triple therapy for 14 days is considered the


    treatment of choice.
    Proton Pump Inhibitor + clarithromycin and metronidazole
    Omeprazole (Prilosec): 20 mg PO bid for 14 d or
    Lansoprazole (Prevacid): 30 mg PO bid for 14 d or
    Rabeprazole (Aciphex): 20 mg PO bid for 14 d or
    Esomeprazole (Nexium): 40 mg PO qd for 14 d plus
    Clarithromycin (Biaxin): 500 mg PO bid for 14 and
    Amoxicillin (Amoxil): 1 g PO bid for 14 d
    In the setting of an active ulcer, continue qd proton pump
    inhibitor therapy for additional 2 weeks.
    Goal: complete elimination of H. Pylori.
    Treatment Plan: Not H. Pylori

    Medicationstreat with Proton Pump Inhibitors alone or


    H2 receptor antagonists to assist ulcer healing + Antacid
    H2 Antagonist: Ranitidine 150mg peroral BD, Cimetidine 400mg peroral BD for up to
    8 weeks
    PPI: Lansoprazole or Omeprazole 20mg peroral OD for 4-8 weeks.
    Topical antacids (eg: Gaviscon, sucralfate, colloidal bismuth) especially for acute
    ulceration postoperative or in ITU patients.
    Indications for Surgical Intervention

    Gastric outlet obstruction not responsive or suitable for endoscopic dilatation


    (pyloroplasty)
    Failure to respond to maximal medical treatment with severe symptoms or
    due to habitual recidivism.
    Emergency indication: - perforation
    - bleeding
    Surgery

    People who do not respond to medication, or who develop


    complications:
    Vagotomy - cutting the vagus nerve to interrupt messages sent
    from the brain to the stomach to reducing acid secretion.
    Antrectomy - remove the lower part of the stomach (antrum),
    which produces a hormone that stimulates the stomach to secrete
    digestive juices. A vagotomy is usually done in conjunction with an
    antrectomy.
    Pyloroplasty - the opening into the duodenum and small intestine
    (pylorus) are enlarged, enabling contents to pass more freely from
    the stomach. May be performed along with a vagotomy.
    Prevention

    Consider prophylactic therapy for the following patients:


    Pts with NSAID-induced ulcers who require daily NSAID therapy
    Pts older than 60 years
    Pts with a history of PUD or a complication such as GI bleeding
    Pts taking steroids or anticoagulants or patients with significant comorbid medical
    illnesses
    Lifestyle Changes

    Discontinue NSAIDs and use Acetaminophen for pain


    control if possible.
    Acid suppression--Antacids
    Smoking cessation
    No dietary restrictions unless certain foods are
    associated with problems.
    Stress reduction
    Complications

    Perforation
    Peritonitis
    Bowel obstruction, Gastric outflow obstruction, & Pyloric stenosis
    Bleeding--occurs in 25% to 33% of cases and accounts for 25% of ulcer deaths.
    Evaluation/Follow-up/Referrals

    H. Pylori Positive: retesting for tx efficacy


    Urea breath testno sooner than 4 weeks after therapy to avoid false negative results
    Stool antigen testan 8 week interval must be allowed after therapy.

    H. Pylori Negative: evaluate symptoms after one month. Patients who are
    controlled should cont. 2-4 more weeks.
    If symptoms persist then refer to specialist for additional diagnostic testing.

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