Peptic Ulcer Disease/Gastritis

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Clinical Description

Commonly caused by Helicobacter pylori.

Other risk factors: NSAIDs chronic use, alcohol, smoking.

Treatment 

NON-PHARMACOLOGICAL

  • Avoid spicy foods
  • Avoid alcohol and tobacco intake
  • Avoid foods that aggravate pain
  • Avoid or reduce on fizzy drinks

PHARMACOLOGICAL

Treatment (Triple Therapy):

  • Omeprazole 40mg 24 hourly for 2 weeks
  • Metronidazole 400mg 8 hourly for 2 weeks
  • Give Amoxycillin 1g 12 hourly for 2 weeks

Alternatively:

  • Omeprazole 20 mg 12 hourly for 2weeks
  • Metronidazole 400mg 8 hourly for 2 weeks
  • Give Clarithromycin 500mg 12 hourly for 2 weeks

Red Flag:

  • Refer for endoscopy and further management if ongoing pain and alarm symptoms
    • weight loss, haematemesis, melaena, anaemia, dysphagia, recent progressive symptoms, age > 16 years.

Aspirin and other non-steroidal anti- inflammatory drugs (NSAIDS) e.g. Indomethacin, Ibuprofen, diclofenac are contraindicated in patients with a history of peptic ulcer disease.

Peptic Ulcer Disease/Gastritis

  • Look for underlying cause and treat accordingly
  • Do not give symptomatic treatment without knowing the cause
  • Exclude mechanical obstruction
    • Recognize that bilious or faeculent vomiting is a sign of mechanical obstruction
    • These patients must be managed at a tertiary facility
  • Correct dehydration as necessary

Treatment:

  • Give Metoclopramide 10 mg IV/IM or PO (if patient can keep food down)

Patients less than 20 years require special caution – they are at higher risk of developing extrapyramidal side effects from metoclopramide. Use alternative anti-emetic if available.

Children:

  • All children with profuse vomiting must be admitted for hydration, observation and investigation. When a guardian comes back with a child who is still vomiting, admit or refer the child. Do not send them home.
  • All children with bilious vomiting should be referred