Chronic gastric ulcer:

1. H2 Receptor blockers - Ranitidine See Algorithm.

3. Six weeks after starting the treatment - Healing should be obtained.

5. If ulcer persists - H.pylori positive - Treat for H.pylori (Table-3) 2 weeks.

6. Surgery is indicated if this treatment fails.

Chronic duodenal ulcer:

1. Antacids (Table -2).

2. H2 Receptor blockers.

3. Proton pump inhibitors.

4. Avoidance of irritants.

Surgery : Indications for operation:

1. Intractable pain / frequent loss of work / recurrence of pain.

2. Complications.

3. Ulcer present for 5 years are unlikely to heal.

4. Suspicion of malignancy.

Table-3: Regimens for H. pylori:

Bismuth Metro Tetra Omeprazole Clarithro Amoxi Duration Cure nidazole cycline mycin cillin

2 Tabs 250 mg 500 mg - - - 1-2 88% AC & AC & AC & weeks

HS HS HS.

2 Tabs 250 mg 500 mg 20 mg BID - - 1 week 94-

AC & AC & AC & 98% HS HS HS.

2 Tabs 250 mg - - - 500 mg 2 80- AC & AC & AC & HS weeks 86%.

HS HS.

- 500 mg bid - 20 mg BID 500 mg BID - 1 week 87- 91%.

- - - 20 mg BID 500 mg BID 1 g BID 1 week 86-

91%*.

- 500 mg bid - 20 mg BID - 1 g BID 2 weeks 77- 83%.

* Slightly higher with 2 weeks of therapy.

Operations for gastric ulcer:

Classic operation is Billroth I partial gastrectomy.

Other procedures are Billroth II gastrectomy / Vagotomy & Pyloroplasty but these two have a high chance of missing ulcer cancer.