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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.