Peptic Ulcer Disease - H. pylori eradication

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This section will only deal with the treatment of H. pylori infection. For full details of peptic ulcer disease treatment see the full Ghana STG.

Investigations

• Haemoglobin
• H. pylori stool antigen
• Oesophago-gastro-duodenoscopy (endoscopy)
• Barium meal (in the absence of endoscopy)
• Stool examination (to exclude intestinal parasites)

Pharmacological Treatment

Helicobacter pylori Eradication

Majority of patients presenting with duodenal ulcer are infected with Helicobacter pylori. Eradication of H. pylori should therefore be done using a 10-14 day course of treatment consisting of a PPI plus a combination of two of the antibiotics indicated in the table below.

Helicobacter pylori Eradication therapy
PPI	Antibiotic
	Amoxicillinξ, oral	Clarithromycin, oral	Metronidazole, oral
Esomeprazole, oral 20 mg 12 hourly	1 g 12 hourly	500 mg 12 hourly	------------
	-----------	500 mg 12 hourly	400 mg 12 hourly
Or Omeprazole, oral 20 mg 12 hourly	1 g 12 hourly	500 mg 12 hourly	----------
	500 mg 8 hourly	----------	400 mg 8 hourly
	----------	500 mg 12 hourly	400 mg 12 hourly
Or Pantoprazole, oral 40 mg 12 hourly	1 g 12 hourly	500 mg 12 hourly	----------
	----------	500 mg 12 hourly	400 mg 12 hourly

ξ Avoid treatment regimens including Amoxicillin in patients with penicillin allergy

Referral Criteria

• Refer for specialist care when there is failure of H. Pylori eradication or if surgery is indicated as stated above.