Gastroduodenal Ulcers (Peptic Ulcer Disease – PUD)- Management

Definition

Gastroduodenal ulcer disease is a disorder resulting from breakdown of the gastric or duodenal mucosal defense mechanisms against hydrochloric acid and proteolytic enzymes. The condition is most commonly associated with:

• Helicobacter pylori infection

• Non-steroidal anti-inflammatory drug (NSAID) use

Clinical presentation

• Burning epigastric abdominal pain

  • Usually relieved by antacids

• Anorexia

• Early satiety

• Abdominal bloating

• Hematemesis

• Melena stools

• Weight loss

Investigations

• Upper gastrointestinal endoscopy demonstrating:

  • Gastric ulceration

  • Duodenal ulceration

Pharmacological treatment

Omeprazole

• Dose: 20 mg

• Route: Oral (PO)

• Frequency: Every 24 hours

• Duration: 8 weeks

OR

Pantoprazole

• Dose: 40 mg

• Route: Oral (PO)

• Frequency: Every 24 hours

• Duration: 8 weeks

OR

Esomeprazole

• Dose: 20 mg

• Route: Oral (PO)

• Frequency: Every 24 hours

• Duration: 8 weeks

AND

Antacid Liquid

• Dose: 10–15 mL

• Route: Oral (PO)

• Frequency: Every 8–12 hours

• Duration: 7–14 days

Management of Bleeding Peptic Ulcer Disease

Referral

• Refer patients with bleeding peptic ulcer disease to higher-level centres for specialist management.

Pantoprazole

• Initial dose: 80 mg stat

• Route: Intravenous (IV)

Then

• Dose: 40 mg

• Route: Intravenous (IV)

• Frequency: Every 12 hours

• Duration: 2–3 days

Then

• Switch to oral pantoprazole as above if bleeding has stopped.

OR

Esomeprazole

• Dose: 40 mg

• Route: Intravenous (IV)

• Frequency: Every 12 hours

• Duration: 2–3 days

Then

• Switch to oral esomeprazole as above if bleeding has stopped.

Monitoring

• Resolution of epigastric pain

• Improvement in appetite

• Evidence of ongoing gastrointestinal bleeding

• Hemodynamic stability in bleeding ulcers

• Response to proton pump inhibitor therapy

Possible Complications

• Upper gastrointestinal bleeding

• Hematemesis

• Melena

• Chronic blood loss

• Weight loss

• Gastric outlet obstruction

• Ulcer perforation