Management

The general management of peptic ulcer disease involves advising the patient to stop smoking, avoid NSAIDs and reduce stress where possible. (1)

Treatment is aimed at determining and eliminating the underlying cause, together with ulcer healing therapy. (2)

Subsequent management can be either medical or surgical.

Note (1)

In duodenal ulcer, acid suppression for 4 to 8 weeks produces healing of the ulcer in 69%. This rises by an extra 5.4% with eradication therapy too. Number needed to treat (NNT) = 18.

In duodenal ulcer, relapse at 3 to 12 months after treatment is 39% after short-term acid suppression alone but eradication increases this by 52% to 91%. NNT = 2.

In gastric ulcer, supplementation of acid suppression with eradication therapy does not improve healing rates but it does reduce relapse so that 3 to 12 months later 45% are free of ulcers after just acid suppression but eradication raises this by 32% to 77%. NNT = 3.

In patients taking NSAIDs, eradication did not improve the ulcer healing rate but it did halve the number of endoscopically proven ulcers six months later from 18% to 9%.

References

1. National Institute for Health and Care Excellence. Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management. September 2019 [internet publication].
2. Test and treat for Helicobacter pylori (HP) in Dyspepsia - Quick Reference Guide for Primary Care. Public Health England. July 2017, updated August 2019.