🩺 General MedicineGastrointestinalStudentInternResident

Peptic Ulcer Disease & H. pylori

Also known as: PUD · gastric ulcer · duodenal ulcer · H pylori · acid peptic disease

Mucosal ulceration of the stomach or duodenum — epigastric pain and dyspepsia, sometimes bleeding. Helicobacter pylori and NSAIDs are the two main causes.

Source · Reviewed 2026-08-15 · v1.0— AI-assisted draft — verify against the cited guideline before clinical use.

⚕️ Education only — not medical advice. Verify against the latest official guideline and your local protocol; confirm every drug dose against the cited source before clinical use.

Who gets it

Adults; risk with H. pylori infection (very common in India), NSAID/aspirin use, smoking, alcohol, and critical-illness stress.

Red flags — escalate / refer

ALARM features — GI bleeding (haematemesis/melaena), anaemia, weight loss, dysphagia, persistent vomiting, a mass, or new dyspepsia over ~45–55 years → urgent endoscopy.
Sudden severe pain with a rigid abdomen → perforation: surgical emergency.

Work-up / diagnosis

1Test for H. pylori (urea breath test or stool antigen) — stop PPIs before testing to avoid false negatives.
2Endoscopy for ALARM features or refractory symptoms.
3Review NSAID/aspirin use and lifestyle factors.

Management — overview

Stop/avoid NSAIDs; advise smoking and alcohol cessation.
Suppress acid with a proton-pump inhibitor (healing course).
If H. pylori positive: give eradication therapy, then confirm cure.
Bleeding ulcer: resuscitate, urgent endoscopy for haemostasis, and IV PPI. Perforation: surgical emergency.

In-depthFull dosing & advanced protocol

Drug dosing

Proton-pump inhibitor (e.g. omeprazole)

Acid suppression / ulcer healing

Adult dose: 20–40 mg once daily; healing course typically 4–8 weeks
Route: Oral

WHOWHO Model List of Essential Medicines (electronic EML) (2025 (24th)) ↗

H. pylori eradication (triple therapy)

H. pylori-positive ulcer

Adult dose: PPI + amoxicillin + clarithromycin for 14 days (use bismuth quadruple therapy where clarithromycin resistance is high)
Route: Oral

Caution: Follow local resistance patterns; confirm eradication after treatment.

ICMRICMR Treatment Guidelines for Antimicrobial Use in Common Syndromes (2019) ↗

IV PPI (bleeding ulcer)

Upper GI bleed from an ulcer

Adult dose: IV PPI plus endoscopic haemostasis
Route: Intravenous

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

Eradication, bleeding & NSAID risk

Choose the eradication regimen by local clarithromycin resistance; confirm cure with a breath/stool test after therapy.
Upper GI bleed: risk-score (e.g. Glasgow-Blatchford), resuscitate, endoscopic therapy and IV PPI.
High NSAID-risk patients: co-prescribe a PPI for gastroprotection.

ICMRICMR Treatment Guidelines for Antimicrobial Use in Common Syndromes (2019) ↗

References

Guidelines change. If something here is out of date, tell us — we keep these current.

🚩 Report outdated / suggest update

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👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Proton-pump inhibitor (e.g. omeprazole)

H. pylori eradication (triple therapy)

IV PPI (bleeding ulcer)

📈 Eradication, bleeding & NSAID risk

📚 References

More protocols

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Proton-pump inhibitor (e.g. omeprazole)

H. pylori eradication (triple therapy)

IV PPI (bleeding ulcer)

📈 Eradication, bleeding & NSAID risk

📚 References

More protocols

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Eradication, bleeding & NSAID risk

References

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Eradication, bleeding & NSAID risk

References