The two major causes of peptic ulcer disease are H. pylori infection and NSAID use. Treatment involves combination therapy for eradication of H. pylori and acid suppression therapy. In patients who need to continue NSAID therapy, maintenance antiulcer therapy should be co-prescribed.
- Peptic ulceration requires eradication of H. pylori if present. Follow up with an investigation such as the urea breath test is necessary to ensure eradication.
- Endoscopy is indicated in older patients with dyspepsia, patients with alarm symptoms or those taking NSAIDs.
- Endoscopy should also be considered in younger patients with dyspepsia of more than two weeks in spite of antacid treatment or a short course of H2-receptor antagonists.
- Patients who have had complicated ulcer disease should have a follow up endoscopy to assess ulcer healing.
- Even low dose aspirin can cause gastroduodenal ulceration. In the setting of cardiovascular or cerebrovascular prophylaxis, less ulcerogenic medications should be considered.
- For prevention of NSAID ulceration in the setting of continued NSAID therapy, co-prescription of a proton pump inhibitor or misoprostol is necessary.
- Maintenance therapy of H2-receptor antagonists at half dosage at night or proton pump inhibitors before breakfast should be considered in patients with a high risk of ulcer.