• University of Michigan Health System. Peptic ulcer disease. Ann Arbor (MI): University of Michigan Health System; 2005 May. 9 p. [7 references]

This is the current release of the guideline.

This guideline updates a previous version: University of Michigan Health System. UMHS peptic ulcer guideline. Ann Arbor (MI): University of Michigan Health System; 1999 May. 6 p.

Note from the National Guideline Clearinghouse (NGC): The following key points summarize the content of the guideline. Refer to the full text for additional information, including detailed information on dosing and cost considerations for therapy for Helicobacter pylori (H. pylori [HP]) associated peptic ulcer disease (PUD).

The levels of evidence [A-D] are defined at the end of the "Major Recommendations" field.

• Clinical approach.

  Ulcers are caused by an infection of a bacterium known as Helicobacter pylori (HP) or H. pylori. Eradication of HP infection alters the natural history of peptic ulcer disease. Successful eradication reduces PUD recurrence rate from 90% to <5% per year [A]. PUD generally does not recur in the successfully treated patient unless nonsteroidal anti-inflammatory drug (NSAID) use is present.

• Diagnosis.

  Economic analyses demonstrate a cost effectiveness advantage of non-invasive testing and antibiotic therapy for HP in patients with symptoms suggestive of PUD when compared to immediate endoscopy. [C] Testing for active HP infection (stool antigen or urea breath testing) is more appropriate than serology testing in areas with low prevalence of active HP infection to reduce unnecessary treatment of individuals without active HP infection.

• Treatment.

  HP eradication therapy consists of antibiotics and anti-secretory drugs. [A] Long-term acid inhibition is inappropriate in the management of HP-related PUD in most instances. [B]

• Follow-up.

  Referral to the gastroenterologist should occur for all patients with signs and symptoms of complicated ulcer disease and for patients who fail initial therapy based on a non-invasive HP test. Persistent symptoms after 2 weeks of therapy suggest an alternative diagnosis.

Definitions:

Levels of evidence for the most significant recommendations:

1. Randomized controlled trials
2. Controlled trials, no randomization
3. Decision analysis
4. Opinion of expert panel

An algorithm is provided in the original guideline document for the management of peptic ulcer disease.

The type of evidence is identified and graded for the most significant recommendations (see "Major Recommendations" field).

• University of Michigan Health System. Peptic ulcer disease. Ann Arbor (MI): University of Michigan Health System; 2005 May. 9 p. [7 references]

Not applicable: The guideline was not adapted from another source.

1996 Oct (revised 2005 May)

University of Michigan Health System - Academic Institution

The University of Michigan Health System (UMHS) provides funding for guideline development. No external funds are used.

Peptic Ulcer Guideline Team

Team Members: A. Mark Fendrick, M.D., General Internal Medicine; Randall T. Forsch, M.D., Family Medicine; R. Van Harrison, Ph.D., Medical Education; James M. Scheiman, M.D., Gastroenterology

Guidelines Oversight Team: Connie J. Standiford, MD; Lee A. Green, MD; R. Van Harrison, PhD

The University of Michigan Health System endorses the Guidelines of the Association of American Medical Colleges and the Standards of the Accreditation Council for Continuing Medical Education that the individuals who present educational activities disclose significant relationships with commercial companies whose products or services are discussed. Disclosure of a relationship is not intended to suggest bias in the information presented, but is made to provide readers with information that might be of potential importance to their evaluation of the information.

Team Member; Relationship; Company

Mark Fendrick, MD, Speaker's bureau, Astra Zeneca, Tap

Consultant, Astra Zeneca, Tap, Meridian Diagnostics

Randall Forsch, MD (None)

Van Harrison, PhD (None)

James Scheiman, MD, Grant/research support, AstraZeneca, Pfizer, Merck Consultant, AstraZeneca, Merck, Nitromed, McNeil, Novartis, TAP, Pfizer, Pozen, The GI Company

Speaker's bureau, AstraZeneca, TAP, Wyeth, Boheringer Ingelheim

This is the current release of the guideline.

This guideline updates a previous version: University of Michigan Health System. UMHS peptic ulcer guideline. Ann Arbor (MI): University of Michigan Health System; 1999 May. 6 p.

None available

This summary was completed by ECRI on August 21, 2000. The information was verified by the guideline developer on November 22, 2000. This summary was updated by ECRI on August 4, 2005. The updated information was verified by the guideline developer on August 10, 2005.

This NGC summary is based on the original guideline, which is copyrighted by the University of Michigan Health System (UMHS).