Gastric ulcer - GU :treatment if H.pylori +ve
- H.pylori eradication therapy as for duodenal ulcer followed by antisecretory therapy for two months
- the reason for this latter recommendation is the lack of evidence that gastric ulcers heal as quickly as DU after H.pylori eradication alone
- long term treatment with a PPI or misoprostol should be considered in patients with proven ulcer who continue to take NSAIDs
- no known single best eradication regime
- One week Triple Therapy - First Line (no continued antisecretory required) PPI (standard dose twice daily) or RBC (ranitidine bismuth citrate), plus Amoxycillin 500 - 1g twice daily or Metronidazole 400-500mg twice daily,plus Clarithromycin 500mg twice daily
- it is sensible to avoid metronidazole if the patient has had a previous course of treatment with this agent
- One week Quadruple Therapy - Second line: PPI (standard dose twice daily), plus Bismuth Subcitrate 120mg qds), plus metronidazole 400-500mg tds, plus tetracycline 500mg qds
- compliance with treatment has been shown to be very important in determining the success of triple therapy
Reference:
- BSG (2002). Dyspepsia management guidelines.
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