Evidence based clinical practice guidelines for peptic ulcer disease 2015
The Japanese Society of Gastroenterology (JSGE) revised the evidence based clinical practice guidelines for peptic ulcer disease in 2014 and has created an English version. The revised guidelines consist of seven items: bleeding gastric and duodenal ulcers, Helicobacter pylori (H. pylori) eradication therapy, non eradication therapy, drug induced ulcer, non H. pylori, non nonsteroidal anti inflammatory drug (NSAID) ulcer, surgical treatment, and conservative therapy for perforation and stenosis. Ninety clinical questions (CQs) were developed, and a literature search was performed for the CQs using the Medline, Cochrane, and Igaku Chuo Zasshi databases between 1983 and June 2012. The guideline was developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Therapy is initially provided for ulcer complications. Perforation or stenosis is treated with surgery or conservatively. Ulcer bleeding is first treated by endoscopic hemostasis. If it fails, surgery or interventional radiology is chosen. Second, medical therapy is provided. In cases of NSAID related ulcers, use of NSAIDs is stopped, and anti ulcer therapy is provided. If NSAID use must continue, the ulcer is treated with a proton pump inhibitor (PPI) or prostaglandin analog. In cases with no NSAID use, H. pylori positive patients receive eradication and anti ulcer therapy. If first line eradication therapy fails, second line therapy is given. In cases of non H. pylori, non NSAID ulcers or H. pylori positive patients with no indication for eradication therapy, non eradication therapy is provided. The first choice is PPI therapy, and the second choice is histamine 2 receptor antagonist therapy. After initial therapy, maintenance therapy is provided to prevent ulcer relapse.
Journal of Gastroenterology