Diagnosis and treatment protocols for Peptic Ulcer Disease in Uganda
Uganda Clinical Guidelines 2023 · all from source →
General Adult
Diagnosis
Clinical Features
Duodenal ulcer: Epigastric pain typically worse at night and when hungry, alleviated by food/milk/antacids. Gastric ulcer: Epigastric pain worse with food. Vomiting, nausea, regurgitation.
Complications (Bleeding/Perforated)
Bleeding: Haematemesis, melena, sudden weakness, cold clammy skin. Perforated: Acute abdominal pain, rigid abdomen, shock.
Investigations
Positive stool antigen for H. pylori (false negatives if taking antibiotics or omeprazole in past 2 weeks). SERUM ANTIBODY TEST IS NOT USEFUL. Gastroscopy, biopsy, barium meal.
Treatment
Symptomatic Relief
Modify diet. Magnesium trisilicate compound 2 tablets every 8 hours as required.
H. pylori Eradication (First Line Triple Therapy)
Amoxycillin 1 g every 12 hours PLUS Metronidazole 400 mg every 12 hours PLUS Omeprazole 20 mg every 12 hours for two weeks. (Tinidazole 500 mg 12-hourly can be used instead of metronidazole). Check eradication with stool antigen test after 4 weeks.
Bleeding and Perforated Ulcer
Refer patient immediately. Give IV fluids and blood if necessary. IV Ranitidine 50 mg in 20 ml slowly every 8 hours.
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