Kijabe Outpatient Guidelines GASTRITIS/PUD

Key Facts:
• Peptic ulcer disease (PUD) includes gastric and duodenal ulcers.
• The most common cause of PUD are Helicobacter pylori infection and use of non-steroidal anti-inflammatory drugs (NSAIDs),
although other causes should be considered.
• Complications of PUD include bleeding, perforation, gastric outlet obstruction, and gastric cancer.

ALARM SYMPTOMS
Suspected gastritis/PUD
• Abnormal vital signs
• Age > 45 yo with new-onset
dyspepsia
• Family history of upper
Alarm
gastrointestinal cancer yes symptoms?
no
• Unintended weight loss
• Gastrointestinal bleeding
• Progressive dysphagia
• Odynophagia
• Unexplained iron deficiency anemia Consider OGD Previous symptoms?
• Persistent vomiting
• Palpable mass or lymphadenopathy
• Jaundice yes no
Consultant review

Resolved with Trial of PPI

First Line PPI treatment?
yes
x 4-6 weeks
Eradication Therapy
(Always write with omeprazole 20mg BD while
on antibiotics.) no

amoxicillin 1gm BD
+ H. pylori stool antigen
clarithromycin 500mg BD neg (only ofter PPI is D/C no Improvement?
( x 14 days) x 2 weeks)
+
PPI pos yes

PCN allergic
Eradication Therapy + PPI PPI as needed after
clarithromycin 500mg BD
x 2 weeks reviewing for alarm
+
symptoms
metronidazole 500mg BD
(x 14 days)
+
PPI yes Symptomatic? no