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Internal Medicine
B) H 2 receptor antagonists
• Include cimetidine, famotidine, ranitidine and nizatidine.
• Cimetidine is the most commonly used drug. The dose is 800 mg at bedtime or
400mg twice a day for 4 - 6 weeks.
• Ranitidine is used at a dose of 150 mg orally twice a day or 300mg at bedtime for
4 – 6 wks.
C) Proton pump inhibitors
• They inhibit the H+-pump, which is important for synthesis of hydrochloric acid.
• Omeperazole: 20mg orally daily for 4 - 8 weeks.
• When these drugs are used for anti- H. pylori treatment, it has direct antimicrobial
effect on the organism.
D) Dietary advice
• There is no specific diet recommended for patients with peptic ulcer disease.
• Patients are generally advised to avoid smoking, coffee, and foods that cause or
aggravate their symptoms.
Surgical treatment is indicated for:
Perforation: immediate surgery is recommended for acute perforation. If this is not
possible, admit the patient to ICU and put on continuous nasogastric suction and
broad-spectrum antibiotics.
Obstruction not responding to medical therapy
Uncontrolled/recurrent bleeding
Suspected malignancy
Symptoms refractory to medical management
For the types of surgical procedures and their complications, please refer Surgical
Is the classic symptom of PUD and is defined as pain centered in the upper
abdomen or discomfort characterized by fullness, bloating, distension or nausea.
It’s a common clinical problem and may be seen in 25 - 40% of adults.
Only 15 - 25% patients with dyspepsia are found to have either gastric or duodenal
Other causes include:
Gastroesophageal reflux disease