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Peptic ulcer treatment approach , medical and surgical

This is a full approach to treatment of Peptic ulcer including different types of drugs with doses and indications of surgical intervention .

A• Medical treatment :

The aim of medical treatment is to relief pain, induce ulcer healing and to prevent recurrence and complications .
1. Diet
- Soft bland diet. It is better to be small and frequent.
- Avoid irritant foods and smoking.
- Avoid excessive milk intake as it may increase acidity due to its calcium content.

2. H2 Blockers 
( for 4-6 weeks to ensure ulcer healing)
- Ranitidine (ZantaC®) 300 mg/D.
- Famotidine (Antodine®) 20-40 mg/D .

3. Proton pump inhibitors (PPIs)
- for 4-8 weeks .
- Omeprazole (LoseC®) 20 mg/D.
- Pantoprazole (ControloC®) 40 mg/D.
- Lanzoprazole (Lanzor®) 30 mg/D.

4. Eradication of H.pylori 
 ( Triple therapy for 2 weeks)
- A proton pump inhibitor e.g omeprazole 20-40mg/D .
- Also 2 antimicrobials are used; Metronidazole 400mgITIDplus amoxycillin 750mg rnD or clarithromycin 500mg/TID are used. Heli-cure is a drug in the market containing tinidazole, omeprazole and clarithromycine, it is given one tab/12hr for 2 weeks .

5. - Avoid NSAIDs, or use selective COX-2 inhibitors.
    - Cessation of smoking.

B. Surgery :

Indications of Surgical treatment of Peptic ulcer

1. Failure of medical treatment.
2. Recurrent uncontrollable hemorrhage.
3. Perforation or penetration.
4. Pyloric obstruction.
5. Possible malignancy .

Types of Surgery :
Details of ( a,b and c ) are in the figure below .
1. Partial gastrectomy:
- Billroth I :  the lower part of the stomach is removed and stomach remnant is connected to duodenum (a) .
- Billroth II : the remnant of the stomach is connected to the first loop of jejunum (polyagastrectomy) (b).
2. Highly selective vagotomy (c).

C. Treatment of Complications :

1. Hemorrhage: 
- Omeprazole: by I.V infusion or ranitidine infusion.
- Endoscopic injection of adrenaline or use of heater probe or laser therapay.
- Blood transfusion: to restore the blood volume rapidly.
- Surgery: for resistant cases.

2. Perforation or penetretion:
Nasogastric suction, IV fluids, antibiotics & analgesics, surgery is performed to repair the perforation with omental patch and drain the abdomen.

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