Assuming H.pylori eradicated and NSAIDs/antiplatelet risk factor withdrawn
Is it 6 weeks, the same duration recommended as for non perforated ulcer healing?
Do we routinely perform gastroduodenoscopy to confirm ulcer healing?
Their are no consesus on the duration. Some practise sixweeks. Some up to six month. I normally continue ppi for at least for a minimum of two months. Then do a ogds survellance. Their is no severe side effect on prolonged ppi therapy. Some even practise life long. There is no increase incident of stomach cancer even after we cause medical acholohydra.
In my practice 6 weeks is the minimum duration as well. At this moment I will perform an upper endoscopy especially to rule out any malignancy. During the initial procedure in the acute setting, the biopsy is not always performed/ recommended. After this period the PPI therapy will be prolonged depending on the Endoscopy findings.
Majority of the peptic ulcer will heal in 4 weeks and some may need an extra 4 weeks more to heal. Hence we usually kept the patient on treatment for 6 weeks. Furthermore, in PGU/PDU, the ulcer has eroded and perforated. In your repair, the healing has been enhanced by surgically approximation. The ulcer edge to edge approximation performed hence, mucosal healing is enhanced.
The duration of PPI therapy should be tailored base on each individual basis. If the cause of the ulcer is Antiplatelets and the patient requires a lifelong antiplatelet to prevent thrombosis, these patients would benefit from lifelong PPI.
Role of endoscopy for reassessment in order to plan for continuation of PPI or for confirmatory of H. Pylori in order to initiate treatment is justifiable.
More importantly, if the patient has all the risk of upper GI malignancy (even though the ulcer edge biopsy is negative for malignancy), an upper endoscopy at 2 to 4 weeks is advisable for a full assessment.
If Hpylori is ngative and gastrin serum level is normal I give PPI for 8 wks .
So, majority practise 6 to 8 weeks of PPI therapy , with endoscopy after that..which will determine the next course of management.
Thank you for sharing!
I usually continue PPI for 8 weeks with a n OGDS at the end to assess the scar and any other pathology. Then, may continue PPI again depends on OGDS findings.
It is important to perform Upper GI endoscopy after about 4-6 weeks to rule out H pylori infection and malignancy, which can not be done at the time of primary procedure for perforated ulcer. And PPI therapy duration depends on findings and results of biopsy performed during Endoscopy.
6 weeks of continuous PPis with check OGD to confirm healing has taken place is adequate.
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