Diagnostic Evaluation

• Radiographic barium study– Less sensitive in small ulcers

<0.5cm– Well-demarcated crater (bulb)

• Endoscopic Procedure– Biopsy sample can be obtained– Therapy can be administered

• Injection of epinephrine or sclerosant into and around vessels

• Coaptive coagulation of vessel using thermal probe or hemoclips

• Urea breath test• Stool antigen

• Acid neutralizing/ Inhibitory drugs– Antacids – AlOH, MgOH

• 100-140 meq/L 1-3 h after meals and hs

– H2 Receptor Antagonists

Cimetidine (400 mg bid), Ranitidine (300 mg hs),

Famotidine (40 mg hs), Nizatidine (300 mg hs)

– Proton Pump Inhibitors Omeprazole (20 mg/d), Lansoprazole (30 mg/d),

Rabeprazole (20 mg/d), Pantoprazole (40 mg/d)

Esomeprazole (20 mg/d)

• Mucosal Protective Agents– Sucralfate (1g qid)– Bismuth-Containing Preparations

• Bismuth subsalicylate (2 tablets qid)

– Prostaglandin Analogues • Misoprostol (200μg qid)

Eradication of H. pylori• Combination Therapy (14 days)

– 2 antibiotics +

either PPI, H2 blocker, or bismuth compound

• Bismuth subsalicylate (2 tablets qid) Metronidazole (250 mg qid)Tetracycline (500 mg qid)

• Ranitidine bismuth citrate (400 mg bid)Tetracycline (500 mg bid)Clarithromycin or Metronidazole (500 mg bid)

• Omeprazole (20 mg bid)Clarithromycin (250 or 500 mg bid)Metronidazole or Amoxicillin (1 g bid)

Surgical Therapy• Vagotomy and drainage

– Ablating cholinergic input– Pyloroplasty/ gastroduodenostomy

• Compensate for vagotomy-induced gastric disorders

• Highly selective vagotomy– Only vagal fibers innervating

portion of stomach with parietal cells are transected

• Vagotomy with antrectomy– Eliminate additional stimulant of

gastric acid secretion, gastrin