Patient handout

Peptic Ulcer Disease

PRODUCTION

1. Your condition

This handout is for peptic ulcer disease. Your care team identified this based on: epigastric pain — relieved or worsened by meals (acg 2024).

Other reasons your team may use this plan: chronic dyspepsia ± alarm features (acg 2024); hematemesis / melena → bleeding pud (acg 2024); acute abdomen + pneumoperitoneum → perforation (acg 2024).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
omeprazole	20-40 mg PO daily × 4-8 weeks	PO	daily 30-60 min before meal	Healing course — duodenal 4 weeks, gastric 8-12 weeks; longer for large or refractory (ACG 2024)
esomeprazole	40 mg PO daily × 4-8 weeks	PO	daily	Equivalent PPI option (ACG 2024)
pantoprazole	40 mg PO/IV daily	PO/IV	daily	IV formulation available for inpatient (ACG 2024)
vonoprazan	20 mg PO daily	PO	daily	P-CAB — faster, longer acid suppression than PPI; superior HP eradication in resistant cases (ACG 2024)

Plan: Peptic ulcer disease — PPI healing + HP eradication + complication management (ACG 2024 + Maastricht VI)

3. Your action plan

Use these zones to know what to do based on how you feel.

GREEN — Healed and protected (ACG 2024)

If you have:

No epigastric pain or dyspepsia
Tolerating regular diet
HP eradication confirmed (if applicable)
On PPI co-prescription if on antiplatelet/OAC

Do this:

Take PPI as prescribed (do not skip)
Avoid NSAIDs and ibuprofen unless approved with PPI
No smoking, moderate alcohol
Keep follow-up EGD if gastric ulcer (8-12w)
HP retest at 4 weeks if treatment course completed

YELLOW — Caution — call provider within 24 hours (ACG 2024)

If you have:

Returning epigastric pain or dyspepsia despite PPI
Mild nausea or early satiety
New iron deficiency symptoms (fatigue, pallor)
Inadvertent NSAID use

Do this:

Continue PPI as prescribed
Avoid NSAIDs, alcohol
Consult clinician about symptom return
Possible HP retest or EGD

Call your provider if:

Symptoms not improving on PPI
New anemia symptoms
NSAID exposure with prior PUD

RED — Medical alert — go to ED now (ACG 2024)

If you have:

Vomiting blood or coffee-ground material
Black tarry stool or red blood per rectum
Severe abdominal pain that gets worse
Sudden severe abdominal pain with rigid belly (perforation)
Lightheadedness or fainting

Do this:

Call 911 / go to nearest ED immediately
Bring updated medication list (especially NSAID/aspirin/anticoag)

Call your provider if:

Any red zone symptom — ED now, do not wait

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Forrest Ia (active spurting), Ib (oozing), IIa (visible vessel) on EGD (ACG 2024)
Free air on upright CXR / CT + peritoneal signs (ACG 2024)(life-threatening)

5. Follow-up

4w symptom check + HP eradication test, 8-12w repeat EGD for gastric ulcer, 2w post-bleed clinic, post-op for perforation, ZES long-term surveillance, PPI step-down assessment (ACG 2024)

6. Sources

Guideline: ACG 2024 H. pylori Guideline (Chey) + Maastricht VI / Florence 2022 + ACG 2021 UGIB (Laine) + AGA 2024 PPI Use Guidance + COMPASS + COGENT + SUP-ICU