GGC Medicines


Adult Therapeutics Handbook

Management of Gastroduodenal Ulcers

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
  • 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 e.g.:

    omeprazole oral 20mg once daily or lansoprazole oral 30mg once daily irrespective of H. pylori status.

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: Only available licensed preparation is for infusion.

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

    omeprazole infusion, 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.

N.B. Continuous infusion of omeprazole is an unlicensed use. Bags should only be prepared immediately before use as no stability data beyond this time period.