Synopsis
Identify gastric and duodenal ulcer disease, address Helicobacter pylori and ulcerogenic medicines, recognise bleeding, perforation and obstruction early, and prove healing where a gastric lesion could conceal malignancy.
- Peptic ulcer is a mucosal break extending beyond the muscularis mucosae, most commonly driven by H. pylori infection or exposure to NSAIDs and aspirin.
- Epigastric pain patterns around meals are not sufficiently accurate to distinguish gastric from duodenal ulcer or to exclude cancer.
- Ask about prescribed and non-prescribed ibuprofen, naproxen, aspirin and combination remedies; corticosteroids, anticoagulants and antiplatelets amplify bleeding risk in combination.
Key red flags
Haematemesis, coffee-ground vomit, melaena, postural symptoms or shock requires acute upper-GI bleeding assessment. Bright rectal blood can occur with a brisk proximal bleed.
Investigation priorities
Confirm ulcer site, describe bleeding stigmata and obtain appropriate tissue.
Management branches
Endoscopy demonstrates a peptic ulcer without active major bleeding, perforation or fixed outlet obstruction.
- Identify active H. pylori and every ulcerogenic medicine, including over-the-counter NSAIDs, low-dose aspirin, steroids, anticoagulants and antiplatelets, then assess tobacco exposure and cancer features.
- Eradicate confirmed H. pylori and prescribe a defined acid-suppression course appropriate to ulcer site and cause; discontinue the offending NSAID where clinically possible.
Key medicines
Proton-pump inhibitor for ulcer healingA licensed example is omeprazole 20 mg once daily for 4–8 weeks; NICE uses a full-dose PPI for eight weeks in NSAID-associated ulcer, with product and duration adjusted to cause and response.
H. pylori eradication treatment when infection is confirmedUse the current seven-day NICE and local antimicrobial combination, selected for penicillin allergy and previous antibiotic exposure; do not copy a historical regimen without checking current strengths and resistance advice.