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1.3 Antisecretory drugs and mucosal protectants

General guidance

Confirmed or suspected ulcer disease

Nearly all duodenal ulcers and most gastric ulcers not associated with NSAIDs are caused by H pylori. The appropriate treatment is H pylori eradication not long term acid suppression.

Gastro-oesophageal reflux disease

There is a lack of comparative data to identify the best approach to the management of GORD – i.e. step-up or step-down.
However, it is widely agreed that patients should be maintained using the agent and dose which provides symptomatic relief at the lowest cost with the least influence on normal physiology.
A stepwise approach should therefore be adopted, with the recognition that the disease severity fluctuates over time.
Patients with severe oesophageal ulceration and/or confirmed Barretts oesophagus should receive long term treatment with a proton pump inhibitor at the dose recommended by the gastroenterologists.