Management of Gastroduodenal Ulcers

Introduction

If Helicobacter pylori infection demonstrated, treat with eradication therapy, as outlined in the guideline here.

Drug therapy

Proton pump inhibitors

Omeprazole oral 40mg once daily for 4 – 8 weeks or

Lansoprazole oral 30mg once daily for 4 – 8 weeks

If the ulcer is associated with non-steroidal anti-inflammatory drug (NSAID):

  • Discontinue the NSAID if at all possible.
  • Repeat endoscopy 2 – 4 weeks after completion of therapy to confirm healing and to check for H.pylori. If latter is positive, eradicate infection as outlined here.
  • If the NSAID needs to be continued or restarted, use in combination with a PPI such as:

    omeprazole oral 20mg once daily or lansoprazole oral 30mg once daily irrespective of H. pylori status. N.B. In some clinical situations a cyclo-oxygenase (COX2) inhibitor may be preferable over an NSAID, for further guidance see the GGC Oral Non-Steroidal Anti-Inflammatory Guideline.

IV proton pump inhibitors

  • If the patient is unable to take oral therapy give:

    omeprazole 40mg by slow IV infusion over 20-30 minutes. NB: Omeprazole administration as IV bolus injection is unlicensed and not recommended.

  • If patient has had endoscopic haemostasis for a bleeding ulcer give:

    omeprazole infusion (Hong Kong Protocol*), initial 80 mg dose (give 80mg in 100ml sodium chloride 0.9% infused over 40 - 60 minutes)

    then followed by:

    continuous infusion* of 8 mg/hour for 72 hours (make up 80mg in 100ml sodium chloride 0.9%, infuse at 10ml (8mg) per hour over 10 hours for a total of 72 hours, a total of 8 infusion bags have to be prepared)

    then followed by oral therapy:

    omeprazole oral 40mg twice daily for 2 weeks then 40mg daily for 6 weeks.

*This is an unlicensed indication.

  NB: Infusion bags should only be prepared immediately before use as there is no stability data beyond this time period.

 

Follow-up

For gastric ulcers only: repeat endoscopy 6-8 weeks after initial endoscopy to confirm ulcer healing.

Check for H.Pylori infection if not previously done - if this is positive, eradicate infection as outlined here.

Long-term management

    • Always advise lifestyle modifications: limit alcohol intake and smoking cessation.
    • Consider stopping other medications that induce peptic ulceration e.g. bisphosphonates, steroids and potassium supplementation.

 

Guideline reviewed: May 2023

Page last updated: August 2023