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