General measures (above) are important
Initially try antacids every 2 hours
Magnesium trisilicate (O) 1-2 chewable tablets or 15 ml mixture every 2 hours
Alternating with: Aluminium hydroxide (O) 1-2 chewable tablets or 15 ml mixture
If symptoms persist, endoscopy or barium meal are necessary (BEFORE H2 - antagonists are prescribed). If DU confirmed, give:
Cimetidine (O) 800 mg at night for 6 weeks. Duration may be reduced to 4 weeks in responsive uncomplicated cases.
For recurrent ulcers on endoscopy, repeat course at same dose. For persistent (non-healing) ulcers on endoscope, repeat course as follows:
Cimetidine (O) 400 mg four times a day for 6 weeks.
NOTE Ulcer healing may be induced by large volume of antacids if H2-antagonists are not available: more than 200 ml or 20 chewable tablets of antacid must be given per day in frequent divided doses half as magnesium trisilicate and half as Aluminium hydroxide, to avoid change in bowel habit. |
Patients with persistent or recurrent ulcers should be referred to a specialist for treatment of Heterobacter Pyloric
Bismuth subcitrate (O) two tablets twice daily for four weeks (repeatable only once)
Or
Omeprazole (O) 20 mg once daily for 4 weeks.
NOTE Cimetidine, Bismuth or Omeprazole by specialist prescription only. |
