Maintenance therapy after H. pylori eradication therapy in adults

Maintenance acid suppression therapy is usually unnecessary for Helicobacter pylori–associated ulcers after successful eradication. However, if H. pylori eradication is not successful or practicable, or if a nonsteroidal anti-inflammatory drug (NSAID) is required, the risk of ulcer recurrence is markedly reduced by treatment with a proton pump inhibitor (PPI) at the standard dose. Use:

1esomeprazole 20 mg orally, daily esomeprazole esomeprazole esomeprazole

OR

1lansoprazole 30 mg orally, daily lansoprazole lansoprazole lansoprazole

OR

1omeprazole 20 mg orally, daily omeprazole omeprazole omeprazole

OR

1pantoprazole 40 mg orally, daily pantoprazole pantoprazole pantoprazole

OR

1rabeprazole 20 mg orally, daily. rabeprazole rabeprazole rabeprazole

For all complicated ulcers, large gastric ulcers, ulcers occurring in high-risk patients or NSAID-induced ulcers, ongoing PPI therapy for about 8 weeks is appropriate. This maximises the likelihood of ulcer healing, particularly in patients who remain infected after eradication therapy. Some patients (especially those who had an ulcer associated with H. pylori infection and NSAID use) may need long-term secondary prophylaxis with PPIs to prevent relapse.

Although PPIs are generally considered safe, there have been reports of serious adverse effects with both short- and long-term use—see long-term use of PPIs.

H2-receptor antagonists can be used but are less effective.