PPI therapy in gastric ulcer disease without H pylori infection

How long should a patient with gastric ulcer disease and no Helicobacter pylori infection be treated with proton pump inhibitors (PPIs)?

Paul Moayyedi, MB ChB, PhD: There are no real guidelines on this. My practice is to carry on at least for a year because you do not know why they have a gastric ulcer and you presume that that risk is still present. I would give them a standard-dose PPI for a year for a gastric ulcer and then I would stop and see if they have symptoms again or not.

I would use symptoms as a guide to whether we need to continue beyond that. But that is not really evidence based or guideline based. These are rare cases, so this is just a physician’s preference.