Treatment peptic ulcer disease

(Lancet 2016;388:2355; Gastro 2016;151:51; Gut 2017;66:6; AJG 2017;112:212)

• If H. pylori ⊕ → eradicate (“test and treat”); if ⊖ → gastric acid suppression w/ PPI

1st line: Quad. Rx: 14d x [MNZ + TCN + bismuth + PPI] or [MNZ + amox + clarith + PPI]

Besides PUD, test & Rx if: gastric MALT lymphoma, s/p resection for early gastric ca, FHx gastric ca, unexplained iron def. anemia, ITP, uninvestigated dyspepsia in Pt <60 y, or when initiating long-term NSAIDs

• “Test-of-cure”: 4 wk after Rx, off PPI x 1–2 wk. Use stool Ag, EGD + RUT, or UBT.

• Lifestyle changes: d/c smoking and probably EtOH; diet does not seem to play a role

• Surgery: if refractory to med Rx (1st r/o NSAID use) or for complic. (see above)