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. pyloripositive 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.

Associations between drugs and small‐bowel mucosal bleeding: Multicenter capsule‐endoscopy study

“…30 In upper gastrointestinal bleeding, a Japanese guideline and another meta-analysis reported that the risk of peptic ulcer complications increases when NSAIDs are given with steroids or anticoagulants. 2,31 We confirmed this effect in relation to small-bowel overt bleeding. NSAIDs induce small-bowel injuries, and other antithrombotic drugs, such as thienopyridine, or steroids, might exacerbate the injury or impair tissue repair and potentially induce small-bowel overt bleeding.…”

Management for non-variceal upper gastrointestinal bleeding in elderly patients: the experience of a tertiary university hospital

“…Although not yet recommended by the international guideline (10) and the latest guidelines in Japan (20,21), the usefulness of non-contrast and contrast CT for UGIB has also been shown (22).…”

Letter: a potassium‐competitive acid blocker vs a proton pump inhibitor for healing endoscopic submucosal dissection‐induced artificial ulcers after treatment of gastric neoplasms

“…1,7 In addition, because concurrent H. pylori infection slows the rate of peptic ulcer healing, 8 concurrent infection, and its eradication, might affect the healing rate of post-ESD ulcers. 9,10 We showed that reduction rates at 2 weeks post-ESD in …”