If Helicobacter pylori infection demonstrated, treat with eradication therapy, as outlined in the guideline here.
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):
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.
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.
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.
Guideline reviewed: May 2023
Page last updated: August 2023