Evidence-based clinical practice guidelines for peptic ulcer disease 2015.

Abstract

The Japanese Society of Gastroenterology (JSGE) revised the evidence-based clinical practice guidelines for peptic ulcer disease in 2014 and has created an English version. The revised guidelines consist of seven items: bleeding gastric and duodenal ulcers, Helicobacter pylori (H. pylori) eradication therapy, non-eradication therapy, drug-induced ulcer, non-H. pylori, non-nonsteroidal anti-inflammatory drug (NSAID) ulcer, surgical treatment, and conservative therapy for perforation and stenosis. Ninety clinical questions (CQs) were developed, and a literature search was performed for the CQs using the Medline, Cochrane, and Igaku Chuo Zasshi databases between 1983 and June 2012. The guideline was developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Therapy is initially provided for ulcer complications. Perforation or stenosis is treated with surgery or conservatively. Ulcer bleeding is first treated by endoscopic hemostasis. If it fails, surgery or interventional radiology is chosen. Second, medical therapy is provided. In cases of NSAID-related ulcers, use of NSAIDs is stopped, and anti-ulcer therapy is provided. If NSAID use must continue, the ulcer is treated with a proton pump inhibitor (PPI) or prostaglandin analog. In cases with no NSAID use, H. pylori-positive patients receive eradication and anti-ulcer therapy. If first-line eradication therapy fails, second-line therapy is given. In cases of non-H. pylori, non-NSAID ulcers or H. pylori-positive patients with no indication for eradication therapy, non-eradication therapy is provided. The first choice is PPI therapy, and the second choice is histamine 2-receptor antagonist therapy. After initial therapy, maintenance therapy is provided to prevent ulcer relapse.

• Authors: Kiichi Satoh, Junji Yoshino, Taiji Akamatsu, Toshiyuki Itoh, Mototsugu Kato, Tomoari Kamada, Atsushi Takagi, Toshimi Chiba, Sachiyo Nomura, Yuji Mizokami, Kazunari Murakami, Choitsu Sakamoto, Hideyuki Hiraishi, Masao Ichinose, Naomi Uemura, Hidemi Goto, Takashi Joh, Hiroto Miwa, Kentaro Sugano, Tooru Shimosegawa
• Journal: Journal of gastroenterology (J Gastroenterol) Vol. 51 Issue 3 Pg. 177-94 (Mar 2016) ISSN: 1435-5922 [Electronic] Japan
• PMID: 26879862 (Publication Type: Journal Article, Practice Guideline, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Bacterial Agents
• Anti-Inflammatory Agents, Non-Steroidal
• Anti-Ulcer Agents
• Cyclooxygenase 2 Inhibitors
• Proton Pump Inhibitors

Topics

• Anti-Bacterial Agents (therapeutic use)
• Anti-Inflammatory Agents, Non-Steroidal (adverse effects)
• Anti-Ulcer Agents (therapeutic use)
• Cyclooxygenase 2 Inhibitors (adverse effects, therapeutic use)
• Drug Therapy, Combination
• Endoscopy, Gastrointestinal (methods)
• Evidence-Based Medicine (methods)
• Helicobacter Infections (complications, drug therapy)
• Helicobacter pylori
• Hemostasis, Endoscopic (methods)
• Humans
• Peptic Ulcer (etiology, therapy)
• Peptic Ulcer Hemorrhage (therapy)
• Proton Pump Inhibitors (therapeutic use)
• Recurrence