Idiopathic peptic ulcers

In a small proportion of patients, no apparent aetiology for ulcer disease is identified. In such cases, ensure the most common causes of peptic ulcer disease have been excluded; consider the possibility of inadvertent or undisclosed nonsteroidal anti-inflammatory drug (NSAID) use (including aspirin), and test to confirm the absence of Helicobacter pylori.

In patients with idiopathic peptic ulcer, trial proton pump inhibitor (PPI) therapy for around 8 weeksKavitt, 2019. Suitable regimens are:

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 peptic ulcers that recur after initial healing with PPI therapy, seek expert advice. Other investigations may also be required (eg fasting serum gastrin to exclude hypersecretory syndromes).