Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18

Peptic Ulcer Disease 1153

more expensive than an UGI

more invasive than an UGI

General Measures

■Stop smoking

■Stop and/or avoid NSAIDs

■Use anti-secretory agents or antacids for breakthrough symptoms

specific therapy

Indications

■A confirmed or suspected diagnosis of an ulcer

Treatment Options

■Helicobacter pyloritherapy if positive (see section onH. pylori)

■Anti-secretory therapy with a H2-receptor antagonist or proton

pump inhibitor for 4–6 weeks

Side Effects

■Dyspepsia, nausea, vomiting, metallic taste with someHelicobacter

pyloritreatments (usually mild)

■Side effects rare with H2RAs or PPIs

Contraindications

■Absolute: allergy to drug

follow-up

Routine

■Complicated peptic ulcer

■Suspected malignant ulcer

■Worried patient

complications and prognosis

Complications

Peptic Ulcer

■Bleeding

■Perforation

■Obstruction

■Symptomatic ulcer

Prognosis

■80% of individuals withH. pylori-related peptic ulcer will relapse

within one year once anti-secretory therapy is discontinued if H.

pylori is not eradicated