Peptic ulcer disease an update on diagnosis and treatment

• Peptic ulceration requires eradication of H. pylori if present. Follow up with an investigation such as the urea breath test is necessary to ensure eradication. • Endoscopy is indicated in older patients with dyspepsia, patients with alarm symptoms or those taking NSAIDs. • Endoscopy should also be considered in younger patients with dyspepsia of more than two weeks in spite of antacid treatment or a short course of H₂-receptor antagonists. • Patients who have had complicated ulcer disease should have a follow up endoscopy to assess ulcer healing. • Even low dose aspirin can cause gastroduodenal ulceration. In the setting of cardiovascular or cerebrovascular prophylaxis, less ulcerogenic medications should be considered. • For prevention of NSAID ulceration in the setting of continued NSAID therapy, co-prescription of a proton pump inhibitor or misoprostol is necessary. • Maintenance therapy of H₂-receptor antagonists at half dosage at night or proton pump inhibitors before breakfast should be considered in patients with a high risk of ulcer.