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Peptic Ulcer Disease - Coggle Diagram
Peptic Ulcer Disease
Diagnosis
Upper endoscopy
Biopsy for H.pylori
Patient history
Presentation
Asymptomatic
Symptomatic
Abdominal pain
GI symptoms: fullness, bloating, early satiety
Bleeding
Obstruction
Perforation
Treatment
Treatment of underlying cause
Eradication of H.pylori
Antibiotic regimens
Clarithromycin-based triple therapy
Clarithromycin BID
Amoxicillin BID
If PCN allergy > metronidazole
PPI BID
Bismuth quadruple therapy
Bismuth subsalicylate QID
Metronidazole QID
Tetracycline QID
PPI BID
Duration = 14 days
Discontinuation of NSAIDs
Anti-secretory therapy
H.pylori +
PPI
Uncomplicated ulcer
Omeprazole 20-40 mg daily x14 days (or equivalent)
Complicated ulcer
IV PPI
High-dose twice daily PO PPI
After 4 weeks, reduce to daily dosing
Duration of 4-12 weeks
NSAID +
PPI x4 weeks
Other
Smoking cessation
Limit alcohol intake
Bland diet/dietary restrictions
Prevention of Recurrence
Avoid NSAIDs/ASA
+/- maintenance antisecretory therapy