Gastrointestinal

Gastritis and Peptic Ulcer Disease (including H. pylori)

معدے کی سوزش / السر

Epigastric pain with vomiting. Check hydration, give IV fluids, a prokinetic and a PPI; test for H. pylori in recurrent cases and eradicate if positive.

ICD-10: —
Source: OPD handbook pp.51–53
Status: Draft

Not yet reviewed by a clinician. Check doses and brands against current national guidelines before use.

Symptoms

Epigastric pain
Vomiting

Diagnosis

Take vitals of all patients
Assess hydration status: eyes, tongue, capillary refill time, skin turgor
If recurrent gastritis or epigastric pain, investigate for H. pylori: stool antigen; if positive, go for H. pylori eradication

Treatment

Step 1 of 4

1. Emergency / acute management

Pass an IV line
Give IV fluids
Give metoclopramide and omeprazole in the IV fluid

Prescription

Normal saline IV (0.9%)IV fluid

Dose1 litre IV

Brands Generic / hospital supply

MetoclopramideProkinetic / antiemetic

Dosein IV fluid

Brand Inj Maxolone

Also sold as Maxolone, Maxolon, Metaclon, Metomide

Omeprazole injection 40 mgProton pump inhibitor (IV)

Dose40 mg in IV fluid

Brand Inj Omeprazole / Risek 40 mg

Step 2 of 4

2. Discharge once the patient tolerates oral intake

Prescription

OmeprazoleProton pump inhibitor

Dose40 mg PO

Brand Ruling sachet 40 mg

Also sold as Risek, Teph, Ruling, Ruling sachet, Omega

MetoclopramideProkinetic / antiemetic

Dose2 tsf TDS

Brand Syp Maxolone 5 mg/5 mL

Also sold as Maxolone, Maxolon, Metaclon, Metomide

Antacid suspension (Dijex MP / Gaviscon Advance / Lagita Advance)Antacid / alginate

Dose2 tsf TDS

Brand Syp Dijex MP

Also sold as Dijex MP, Gaviscon Advance, Lagita Advance (as written), Mucaine

Step 3 of 4

3. Antibiotic (if febrile or food poisoning suspected)

Drug of choice: ciprofloxacin

Prescription

CiprofloxacinFluoroquinolone antibiotic

Dose500 mg BD (1+1)

Brand Tab Novidat 500 mg

Also sold as Novidat, Mercep, Cipro, Ciproxin, Ciprin

Step 4 of 4

4. H. pylori eradication (triple therapy)

The eradication regimen is written for 7 days in the sample prescription.

Test: stool antigen for H. pylori; if positive, eradicate
Triple therapy: clarithromycin 500 mg BD + amoxicillin 1 g BD + PPI 20 mg or 40 mg BD

Prescription

ClarithromycinMacrolide antibiotic

Dose500 mg BD (1+1)

Brand Tab Pyloclar 500 mg

Also sold as Klaricid, Rithmo, Pyloclar, Claricid

AmoxicillinPenicillin antibiotic

Dose2+2 (1 g BD)

Brand Tab Amoxil 500 mg

Also sold as Amoxil, Dispermox

Caution: Penicillin allergy

OmeprazoleProton pump inhibitor

Dose20 mg or 40 mg BD (1+1)

Brand Cap Ruling 40 mg / Ruling sachet 40 mg

Also sold as Risek, Teph, Ruling, Ruling sachet, Omega

ItoprideProkinetic

Dose1+1

Brand Tab Itopar 50 mg

Also sold as Itopar, Ganaton

MetoclopramideProkinetic / antiemetic

Dose2+2+2 tsf

Brand Syp Maxolone 5 mg/5 mL

Also sold as Maxolone, Maxolon, Metaclon, Metomide

Antacid suspension (Dijex MP / Gaviscon Advance / Lagita Advance)Antacid / alginate

Dose2+2+2 after meals

Brand Syp Dijex MP

Also sold as Dijex MP, Gaviscon Advance, Lagita Advance (as written), Mucaine

Sample from the book (patient details removed)

Male, 40 y, epigastric pain, 4 episodes in the last year with vomiting; mild tenderness; stool H. pylori positive. Plan: IV line; N/S 1 litre IV stat; Inj Maxolone in IV fluid; Inj Risek 40 mg in IV fluid. Rx for 7 days: Tab Pyloclar 500 mg 1+1; Tab Amoxil 500 mg 2+2; Ruling sachet 40 mg 1+1; Syp Maxolone 5 mg/5 mL 2+2+2 tsf; Syp Dijex MP 2+2+2 after meals.