Editing Peptic ulcer disease (section)

== '''Medical management''' ==

=== '''Uncomplicated     PUD (also needed for all other situations below):''' ===

** H . Pylori eradication
*** HP7 - see separate topic
** Avoid NSAIDs/steroids
*** Will need 8 weeks of PPI,       and consider maintenance PPI if need to stay on NSAIDs long-term
** Stop smoking
** Restrict EtOH to one per day
** Antacids
*** See description under       'GORD' topic
*** Mostly replaced by       antisecretory therapy in modern times, but can be used for symptom       control
** Sucralfate
*** See 'GORD' topic
*** Not clearly established to       benefit PUD
** Histamine antagonists
*** See 'GORD'
*** Despite differences in       potency, RCTs have demonstrated that all H2-receptor antagonists result       in healing rates of 70-80% after 4 weeks and 80-90% after 8 weeks
** PPIs
*** See 'GORD'
*** Most potent anti-secretory       agent
*** Healing rate 85% at 4 weeks       and 96% at 8 weeks

=== '''Uncomplicated     gastric ulcers:''' ===

**

=== '''Complicated     gastric ulcers:''' ===

** PPI 8 weeks (often needs      repeat endoscopy to confirm healing before ceasing therapy)

=== '''Uncomplicated     duodenal ulcers:''' ===

** PPI 14 days
** Abx
** If asymptomatic      post-treatment, no further PPI/Abx needed, and can confirm eradication

=== '''Complicated     duodenal ulcers:''' ===

** PPI 8 weeks

=== '''Ulcers     secondary to H. pylori''' ===

** See separate topic

=== '''Ulcers     secondary to NSAIDs''' ===

** PPI (6 weeks if <1cm, 8      weeks if >1cm)
** Cease NSAIDs
** Lifelong PPI if:
*** Persistent ulcer on repeat       scope
*** >2cm ulcer and age       >50 or multiple comorbidities
*** Recurrent peptic ulcers
*** Condition requiring       long-term NSAID use

=== '''Ulcers not     associated with NSAIDs or H. pylori:''' ===

** PPI 4 weeks for duodenal      ulcer, 8 weeks for gastric ulcer
** Repeat endoscopy, especially      for gastric ulcers
** See above workup
** If workup negative, probably      needs lifelong PPI

=== '''Persistent     ulcers at repeat scope''' ===

** Biopsy for malignancy
** Consider medications, H      pylori, smoking, alcohol
** Consider ZES