PPIs in duodenal ulcer disease associated with H pylori

How long should proton pump inhibitors (PPIs) be used in a patient with duodenal ulcer disease associated with Helicobacter pylori infection? How long should the treatment be continued after H pylori eradication?

Paul Moayyedi, MB ChB, PhD: There is no guideline on that because randomized trials show that H pylori eradication alone is usually sufficient to heal ulcers. Having said that, most gastroenterologists will carry on the PPI for at least 4 weeks and perhaps for 8 weeks. Beyond that, there is no good indication to continue the PPI unless, as I said [see Indications for long-term PPI treatment], the patients are at a very high risk of gastrointestinal bleed. You would normally stop at that point because H pylori has been eradicated and that is the main cause of peptic ulcer disease.

The only time you give long-term PPIs is if patients are H pylori–negative and have ulcers.