Management of Gastroduodenal Ulcers

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.