Gastroenterology and hepatology
Peptic ulcer disease and Helicobacter pylori
H. pylori and NSAIDs as the two main causes, gastric versus duodenal ulcers, testing at endoscopy, eradication and confirming cure, NSAID and aspirin strategy after an ulcer (CONCERN), perforation and outlet obstruction, refractory ulcers and Zollinger-Ellison syndrome.
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- A peptic ulcer is a mucosal break of at least 5 mm reaching the submucosa, in the stomach or duodenum. H. pylori and NSAIDs or aspirin cause most.
- Many ulcers are silent until they bleed or perforate, especially in older people on NSAIDs.
- Every ulcer needs: PPI healing, H. pylori testing and eradication, and a decision about NSAIDs and antithrombotics.
Loading the rest of the note…
Finished reading?
Sources
- Therapeutic Guidelines: Gastrointestinal (eTG complete), peptic ulcer disease and Helicobacter pyloriAU/NZTherapeutic Guidelines Limited, current eTG edition (version not verified)
- Malfertheiner P et al. Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report. Gut 2022European Helicobacter and Microbiota Study Group (Gut), 2022
- Chey WD et al. ACG Clinical Guideline: Treatment of Helicobacter pylori Infection. Am J Gastroenterol 2024;119:1730-53American College of Gastroenterology, 2024
- Sugimoto M, Kamada T et al. Evidence-based clinical practice guidelines for peptic ulcer disease 2026. J Gastroenterol 2026;61:1361-81Japanese Society of Gastroenterology, 2026
- Gralnek IM et al. Endoscopic diagnosis and management of peptic ulcer bleeding: ESGE Guideline, Update 2026. Endoscopy 2026;58:899-924European Society of Gastrointestinal Endoscopy, 2026
- Chan FKL et al. Gastrointestinal safety of celecoxib versus naproxen in patients with cardiothrombotic diseases and arthritis after upper gastrointestinal bleeding (CONCERN). Lancet 2017;389:2375-82The Lancet, 2017
- Cook D et al. Stress ulcer prophylaxis during invasive mechanical ventilation (REVISE). N Engl J Med 2024;391:9-20New England Journal of Medicine, 2024
- Klacid (clarithromycin) Australian Product Information, section 4.6 (pregnancy category B3)AU/NZViatris, revised 19 May 2026
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Turnstile bot check on sign-in and signed-out feedback