Peptic Ulcers

exp date isn't null, but text field is

Treatment of peptic ulcer disease begins with exclusion of aetiologic factors such as NSAIDs and eradication of Helicobacter pylori. Acid suppression therapy is also required. Cigarette smoking must be avoided. "Ulcer diets" are unnecessary. Avoid foods that exacerbate pain in individual patients. Antacid may give temporary relief of symptoms.

Alarm features: The presence of alarm features are an indication for immediate referral to a specialist i.e. patient of any age with overt bleeding, iron deficiency anaemia, progressive unintentional weight loss, progressive difficulty swallowing, persistent vomiting, epigastric mass or suspicious barium meal. Gastric ulcer at barium meal requires referral for endoscopic biopsy.

For H. pylori eradication:

	Medicine	Adult dose	Frequency	Duration
	amoxicillin po*	1g	twice a day	2 weeks
and	clarithromycin po	500mg	twice a day	2 weeks
and	omeprazole po	20mg	twice a day	2 weeks
	*penicillin allergic patient metronidazole po	400mg	twice a day	2 weeks

ALTERNATIVELY if clarithromycin is unsuitable/unavailable

	Medicine	Adult dose	Frequency	Duration
	amoxicillin po	500g	3 times a day	2 weeks
and	metronidazole po	400mg	3 times a day	2 weeks
and	omeprazole po	20mg	two times a day	2 weeks

This regime may be more poorly tolerated, affecting compliance

Note: Omeprazole must be taken half hour before meals.

Incomplete or abbreviated courses risk development of antibiotic resistance.

Persistence of H. pylori infection is indication for referral to a specialist. Preferred test for H. pylori is stool antigen test; antibody test is unreliable unless locally validated, Endoscopy-based tests are unsuitable for routine use.

For guidance on management of ulcers related to NSAIDs and dyspepsia see full Zimbabwe STG.