Evidence-based clinical practice guidelines for peptic ulcer disease 2020

Area of Science:

• Gastroenterology
• Internal Medicine
• Pharmacology

Background:

• The Japanese Society of Gastroenterology (JSGE) updated its evidence-based clinical practice guidelines for peptic ulcer disease in 2020.
• An English version of these comprehensive guidelines is now available.

Purpose of the Study:

• To provide updated, evidence-based clinical practice guidelines for the management of peptic ulcer disease.
• To outline therapeutic algorithms for various peptic ulcer types and complications.
• To detail strategies for the prevention of NSAID- and aspirin-related ulcers.

Main Methods:

• The guidelines cover nine key areas: epidemiology, hemorrhagic ulcers, H. pylori eradication, non-eradication therapy, drug-induced ulcers, remnant ulcers, surgical treatment, and conservative management of perforation/stenosis.
• Therapeutic algorithms are presented based on ulcer complications and patient history.
• Recommendations for H. pylori eradication include vonoprazan (VPZ) with antibiotics as first-line and PPIs or VPZ as second-line therapy.

Main Results:

• Treatment algorithms differ based on ulcer complications, such as NSAID-induced ulcers.
• For H. pylori eradication, VPZ with antibiotics is recommended first-line.
• Prevention algorithms for NSAID- and LDA-related ulcers are provided, varying by concomitant medication use and ulcer history.

Conclusions:

• The guidelines offer structured approaches to peptic ulcer management, emphasizing H. pylori eradication and prevention of NSAID/aspirin-induced ulcers.
• Vonoprazan and proton pump inhibitors (PPIs) are key pharmacotherapies recommended.
• Specific algorithms guide the prevention of ulcer recurrence in patients on NSAIDs or low-dose aspirin.