Please note: this guideline has exceeded its review date and is currently under review by specialists. Exercise caution in the use of the clinical guideline.

Management of Gastroduodenal Ulcers

Introduction

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

Drug therapy

PO 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:

    esomeprazole 40mg by slow IV infusion over 30 minutes.

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

    esomeprazole infusion, initial 80 mg dose (give 80mg in 100ml sodium chloride 0.9% infused over 30 minutes)

    then followed by:

    continuous infusion of 8 mg/hour for 71.5 hours (make up 80mg in 100ml sodium chloride 0.9%, infuse at 10ml (8mg) per hour over 10 hours for a total of 71.5 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. If ongoing need thereafter, consider a low dose PPI or H2 antagonist.

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

 

Guideline reviewed August 2020
Page updated November 2022



;