Peptic Ulcer Treatment Overview in 5 Points

Contents

1. Intro
2. Mgmt approach
3. References

Intro

🌟 Peptic ulcers can be effectively treated with medications that reduce acid production, eradicate H. pylori, and protect the stomach lining. Here's a quick guide to first-line and second-line treatments, with key precautions and considerations for special populations.👇

Mgmt approach

• [1] First-Line: Acid Suppression
• PPIs: High efficacy, most duodenal ulcers heal in 4 wks.
• Examples: Omeprazole (Losec) 20mg/day, Lansoprazole (Lanzor) 30mg/day, Esomeprazole (Nexium) 40mg/day. 🕒 Tx Duration: 4-8 wks.
• ⚠️ Precautions: 🦴 ↓ Bone density → bone scans recommended for long-term use; 🦠 ↑ Risk of CAP, C. diff; ⚡ Possible hypomagnesemia; ✅ Safe with clopidogrel (no ↓ efficacy).
• H2 Blockers: Safer for long-term use.
• Examples: Ranitidine (Ranitidine) 150mg BID (N.B: withdrowal from market), Famotidine (Antodine) 20mg BID, adjust dose if CrCl <50 mL/min. 🕒 Tx Duration: 4-8 wks.
• [2] NSAID-Induced Ulcers: 💊 PPIs (healing occurs >85%) > H2 blockers for effectiveness; 🛑 Stop NSAID or lower dose. 🕒 Tx Duration: 6-8 wks.
• [3] H. pylori-Induced Ulcers
• 🦠 Clarithromycin Triple: PPI + clarithromycin 500mg BID + amoxicillin 1g BID.
• 💊 Bismuth Quad: PPI + bismuth + tetracycline + metronidazole.
• [4] 2nd Line (if failure)
• Levofloxacin Triple: PPI + amoxicillin 1g BID + levofloxacin 500mg QD.
• Levo Quad: PPI + levofloxacin 250mg + doxycycline 100mg.
• [5] Pregnancy & Lactation
• PPIs are safe. 🤰
• Ranitidine (withdrowal from market) & esomeprazole are safe for breastfeeding. 🤱

References

1. Lanas A, Chan FKL. Peptic ulcer disease. Lancet. 2017;390(10094):613–624.
2. Narayanan M, Reddy KM, Marsicano E. Peptic ulcer disease and Helicobacter pylori infection. Mo Med. 2018;115(3):219–224.