Peptic ulcer disease is characterized by mucosal ulceration in the stomach or duodenum. It is commonly caused by Helicobacter pylori or by excessive use of non-steroidal anti-inflammatory drugs.
Medications:
For Helicobacter pylori eradication-
- Tab. Pantocid HP (Amoxicillin 750 mg, Pantoprazole 40 mg, Clarithromycin 500 mg) 1 tablet twice a day for 14 days AND
- Tab. Flagyl (Metronidazole 400 mg) 1 tablet twice a day for 14 days.
- After 14 days – Tab. Pantakind (Pantoprazole 20 mg) 1 tablet once at bedtime for next 6 weeks.
For NSAID induced peptic ulcer-
- Tab. Pantakind (Pantoprazole 40 mg) 1 tablet once a day on empty stomach for 4 weeks. Reduce this to 20 mg once a day at bedtime for next 4 weeks.
Supportive treatments:
- Syp. Gelusil (Aluminium hydroxide, Magnesium hydroxide, Simethicone) 15 ml thrice a day.
- Tab. Redic (Dicyclomine 10 mg) 1 tablet thrice a day (15 minutes before meals) for two weeks for abdominal pain.
General advice:
- Lifestyle modification – advice good sleep hygiene, avoid stressful environments.
- Consume adequate amounts of water to maintain good hydration and urine output.
- Advice cessation of smoking and alcohol.
- Avoid fatty foods, chocolates, garlic, onion, coffee, spices, tomato sauce or milk products towards end of day.
Investigations:
- Blood biochemistry – to identify antibodies to Helicobacter pylori.
- Stool biochemistry – to identify antigen related to Helicobacter pylori and occult blood.
- Urea breath test – this will be positive in H Pylori infection.
- Gastrointestinal endoscopy – to confirm ulcerations and bleeding areas.
Referral:
Consider referral to gastroenterologist if patient fails to respond. Consider urgent referral to secondary care hospital in case of evidence of excessive gastrointestinal bleed, severe anaemia or hemodynamic instability.