Peptic ulcer medical therapy
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Peptic ulcer Microchapters |
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Diagnosis |
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Treatment |
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Surgery |
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Case Studies |
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2017 ACG Guidelines for Peptic Ulcer Disease |
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Guidelines for the Indications to Test for, and to Treat, H. pylori Infection |
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Guidlines for factors that predict the successful eradication when treating H. pylori infection |
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Guidelines to document H. pylori antimicrobial resistance in the North America |
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Guidelines for evaluation and testing of H. pylori antibiotic resistance |
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Guidelines for when to test for treatment success after H. pylori eradication therapy |
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Guidelines for penicillin allergy in patients with H. pylori infection |
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Peptic ulcer medical therapy On the Web |
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American Roentgen Ray Society Images of Peptic ulcer medical therapy |
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Risk calculators and risk factors for Peptic ulcer medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]
Overview
The mainstay of treatment for peptic ulcer disease is pharmacotherapy. All patients with a gastric or duodenal peptic ulcer should be evaluated for Helicobacter pylori infection and for nonsteroidal anti-inflammatory drug (NSAID) or aspirin use, as these represent the two dominant etiologies. Treatment of H. pylori with antimicrobial agents is indicated for all patients with active gastric or duodenal ulceration who test positive for the infection.
The pharmacologic approach to H. pylori-associated PUD involves a combination of a proton pump inhibitor (PPI) or potassium-competitive acid blocker (PCAB) plus two or three antimicrobial agents. The 2024 American College of Gastroenterology (ACG) Clinical Guideline substantially revised first-line eradication strategy: standard PPI–clarithromycin triple therapy is no longer recommended empirically, given rising resistance rates to clarithromycin and levofloxacin in North America. Optimized bismuth quadruple therapy (BQT) is now the recommended first-line regimen; rifabutin-based triple therapy and vonoprazan-based regimens are endorsed as alternatives.[1] After treatment, confirmation of eradication is mandatory using a urea breath test or monoclonal fecal antigen test at least 4 weeks after completing antibiotics and at least 2 weeks after stopping all acid-suppressive therapy. If the patient remains infected, the regimen is planned according to prior antibiotic exposure, documented resistance, and remaining treatment options.
For non-H. pylori, non-NSAID (idiopathic) ulcers, long-term acid suppression is the foundation of therapy. The use of antimicrobial therapy is discouraged among asymptomatic H. pylori carriers without an established indication.
Medical Therapy
Eradication Therapy for Helicobacter pylori Infection
Indications for Testing and Treatment
The ACG 2024 Clinical Guideline endorses testing and treating H. pylori in the following established settings:[1]
- Active peptic ulcer disease (gastric or duodenal)
- Confirmed history of PUD not previously treated for H. pylori
- Gastric MALT lymphoma (low-grade)
- After endoscopic resection of early gastric cancer
Diagnosis of H. pylori
Noninvasive testing with the urea breath test (UBT) or a laboratory-validated monoclonal fecal antigen test is preferred in the outpatient setting. Serology has inferior specificity and should not be used to confirm active infection or eradication. When esophagogastroduodenoscopy is performed, biopsy-based tests (histology, rapid urease test, or culture) are appropriate. PPIs must be withheld for at least 2 weeks and antibiotics for at least 4 weeks before noninvasive testing to avoid false-negative results.
First-Line Eradication Therapy (2024 ACG Guideline)
The 2024 ACG guideline represents a major departure from the 2017 version. PPI–clarithromycin triple therapy (PCA and PCM regimens) is no longer recommended empirically as first-line treatment due to high clarithromycin resistance rates in North America. Concomitant therapy (PPI + amoxicillin + clarithromycin + nitroimidazole simultaneously) is also not recommended over BQT for treatment-naive patients.[1] The following regimens are currently recommended or suggested for treatment-naive patients:
| Regimen | Drugs and Doses | Frequency | Duration | ACG Grade | FDA Status |
|---|---|---|---|---|---|
| Optimized Bismuth Quadruple Therapy (BQT) — PREFERRED | PPI (standard dose) Bismuth subcitrate 120–300 mg or bismuth subsalicylate 300 mg Tetracycline 500 mg Metronidazole 500 mg |
BID QID QID TID or QID |
14 days | Strong; moderate-quality evidence | Pylera (combination): FDA-approved for 10 days with PPI |
| Rifabutin Triple Therapy (PAR / Talicia) | PPI standard dose (or omeprazole 40 mg) Amoxicillin 1 g (or 250 mg per Talicia capsule) Rifabutin 150 mg (or 50 mg per Talicia capsule) |
BID (or TID for Talicia) | 14 days | Conditional; low-quality evidence | Talicia: FDA-approved (2019); TID dosing |
| Vonoprazan–Amoxicillin Dual Therapy (Voquezna DualPak) | Vonoprazan 20 mg Amoxicillin 1 g |
BID TID |
14 days | Conditional; moderate-quality evidence | FDA-approved (2022) |
| Vonoprazan–Clarithromycin Triple Therapy (Voquezna TriplePak) | Vonoprazan 20 mg Amoxicillin 1 g Clarithromycin 500 mg |
BID BID BID |
14 days | Conditional; moderate-quality evidence (suggested over PPI–clarithromycin triple when clarithromycin susceptibility is unknown) | FDA-approved (2022) |
| PPI–Clarithromycin Triple Therapy | PPI standard dose Clarithromycin 500 mg Amoxicillin 1 g or metronidazole 500 mg |
BID BID BID or TID |
14 days | Not recommended empirically — use only if clarithromycin susceptibility has been confirmed by testing | Several combinations FDA-approved |
Key points on optimization of BQT:
- Tetracycline (500 mg QID) must be used; doxycycline should not be substituted as it reduces eradication rates by 10–17%[1]
- The total daily metronidazole dose should be ≥1,500 mg (e.g., 500 mg TID or QID), which helps overcome low-level metronidazole resistance
- Bismuth dose should provide ≥1,200 mg elemental bismuth per day (e.g., bismuth subsalicylate 300 mg QID or bismuth subcitrate 120–300 mg QID)
- Patients with a penicillin allergy should receive BQT as primary therapy; rifabutin and vonoprazan-based regimens also require amoxicillin and cannot be used in true penicillin allergy — referral to an allergist for penicillin desensitization should be considered, as fewer than 1% of the population has a confirmed true penicillin allergy[1]
- Standard PPI doses: Lansoprazole 30 mg BID, Omeprazole 20 mg BID, Esomeprazole 40 mg BID, Rabeprazole 20 mg BID, Pantoprazole 40 mg BID
Selection of First-Line Therapy — Decision Algorithm
| Does the patient have a confirmed or suspected penicillin allergy? | |||||||||||||||||||||||||||
| No penicillin allergy | Penicillin allergy present | ||||||||||||||||||||||||||
| Preferred: Optimized BQT × 14 days Alternatives (no PCN allergy): • Rifabutin triple (PAR/Talicia) × 14 days • Vonoprazan–amoxicillin dual × 14 days • Vonoprazan–clarithromycin triple × 14 days (if clarithromycin susceptibility confirmed: PPI–clarithromycin triple × 14 days) | Preferred: Optimized BQT × 14 days (Bismuth + tetracycline + metronidazole + PPI) Rifabutin/vonoprazan regimens require amoxicillin → not suitable without allergy workup | ||||||||||||||||||||||||||
Post-Treatment Test of Cure
A post-treatment test of cure is mandatory for all patients treated for H. pylori.[1] The UBT or monoclonal fecal antigen test should be performed:
- At least 4 weeks after completing antibiotic therapy, AND
- At least 2 weeks after stopping all acid-suppressive therapy (PPI or PCAB)
Serology should not be used for post-treatment confirmation. A positive result constitutes treatment failure and requires a salvage strategy.
Persistent Helicobacter pylori Infection (Treatment-Experienced Patients)
In patients with persistent H. pylori infection after a first course of therapy, every effort should be made to avoid antibiotics previously used, as resistance is the most common cause of treatment failure. Prior exposure to macrolides (clarithromycin) or fluoroquinolones (levofloxacin) should prompt avoidance of these agents unless susceptibility is confirmed. Amoxicillin, tetracycline, and rifabutin resistance is uncommon and these agents can generally be used in subsequent regimens.[2]
The 2024 ACG guideline specifies the following for treatment-experienced patients:[1]
- Failed PPI–clarithromycin triple therapy → Optimized BQT × 14 days is the preferred next step (strong recommendation)
- Failed optimized BQT → Rifabutin triple therapy × 14 days is the preferred empiric alternative
- Clarithromycin- or levofloxacin-based salvage regimens should only be used if antibiotic susceptibility testing (phenotypic culture or molecular PCR from gastric biopsy) has confirmed sensitivity
- After two or more eradication failures, antibiotic susceptibility testing is strongly encouraged before selecting the next regimen
| Persistent Helicobacter pylori infection after first-line therapy | |||||||||||||||||||||||||||||||||||
| Failed PPI–clarithromycin triple therapy | Failed optimized bismuth quadruple therapy (BQT) | ||||||||||||||||||||||||||||||||||
| Preferred: Optimized BQT × 14 days (if no prior BQT exposure) Alternatives (based on antibiotic history): • Rifabutin triple therapy × 14 days • Vonoprazan–amoxicillin dual × 14 days • Levofloxacin triple × 14 days (only if levofloxacin susceptibility confirmed) | Preferred: Rifabutin triple therapy × 14 days Alternatives: • Levofloxacin triple × 14 days (only if susceptibility confirmed) • Vonoprazan-based dual or triple therapy • High-dose dual (PCAB or double-dose PPI + amoxicillin) Consider: Antibiotic susceptibility testing before empiric selection | ||||||||||||||||||||||||||||||||||
Salvage Treatment Regimens
| Regimen | Drug (Dose) | Frequency | Duration | Notes |
|---|---|---|---|---|
| Optimized BQT | PPI (standard dose) Bismuth subcitrate 120–300 mg or bismuth subsalicylate 300 mg Tetracycline 500 mg Metronidazole 500 mg |
BID QID QID TID–QID |
14 days | Preferred after failed clarithromycin triple therapy; do not substitute doxycycline for tetracycline |
| Rifabutin Triple (PAR / Talicia) | PPI standard dose (or omeprazole 40 mg) Amoxicillin 1 g (or 250 mg per Talicia capsule) Rifabutin 150 mg (or 50 mg per Talicia capsule) |
BID (Talicia: TID) | 14 days | Preferred after failed BQT; low rifabutin resistance; monitor CBC for myelotoxicity |
| Levofloxacin Triple | PPI standard dose Levofloxacin 500 mg Amoxicillin 1 g |
BID QD or BID BID |
14 days | Use only if levofloxacin susceptibility confirmed; rising fluoroquinolone resistance limits empiric use |
| High-Dose Dual Therapy | PCAB (vonoprazan 20 mg) or double-dose PPI Amoxicillin 1 g |
BID TID–QID |
14 days | Alternative when other options are exhausted; best data with vonoprazan |
| Vonoprazan–Clarithromycin Triple | Vonoprazan 20 mg Amoxicillin 1 g Clarithromycin 500 mg |
BID | 14 days | Salvage only if clarithromycin susceptibility confirmed |
Note: Pylera (bismuth subcitrate potassium 140 mg + tetracycline 125 mg + metronidazole 125 mg per capsule, 3 capsules QID) combined with a PPI for 10 days is an FDA-approved fixed-dose BQT formulation.
Talicia (omeprazole 40 mg + amoxicillin 1000 mg + rifabutin 50 mg per dose, TID) is FDA-approved for 14 days.
Voquezna DualPak (vonoprazan 20 mg BID + amoxicillin 1 g TID) and Voquezna TriplePak (vonoprazan 20 mg BID + amoxicillin 1 g BID + clarithromycin 500 mg BID) are FDA-approved for 14 days.
Medical Therapy for Non-Helicobacter pylori-Associated Peptic Ulcer Disease
NSAIDs are the most common cause of non-H. pylori-associated peptic ulcer disease. The first step in management is to discontinue the offending NSAID whenever clinically feasible. If the NSAID cannot be stopped, a full-dose PPI should be co-prescribed throughout the duration of NSAID use.
Acid Suppression: Active Ulcer Therapy
PPIs are the agents of choice for healing active peptic ulcers. Standard-dose PPI once daily for 4 weeks heals >90% of duodenal ulcers. 6–8 weeks of PPI is generally required for gastric ulcer healing.[3] PPIs should be taken 30–60 minutes before the first meal of the day to optimize efficacy. Histamine-2 receptor antagonists (H2RAs) are inferior to PPIs and are now second-line agents.
| Active Ulcer — Recommended Drugs and Doses | |
|---|---|
| Drug Class | Agent and Dose |
| Proton pump inhibitors (first-line) | Omeprazole 20 mg PO once daily (before breakfast) |
| Lansoprazole 30 mg PO once daily | |
| Rabeprazole 20 mg PO once daily | |
| Pantoprazole 40 mg PO once daily | |
| Esomeprazole 40 mg PO once daily | |
| Histamine-2 receptor antagonists (second-line; inferior to PPI) | Famotidine 40 mg PO once daily at night |
| Nizatidine 300 mg PO once daily at night | |
| Cimetidine 800 mg PO once daily at night | |
Note: Ranitidine was withdrawn globally in 2020 due to NDMA contamination and should not be prescribed.
Acid Suppression: Maintenance Therapy
Long-term maintenance acid suppression is required for:
- Patients with idiopathic (non-H. pylori, non-NSAID) ulcers (high recurrence rate)
- Patients who must continue chronic NSAID or aspirin therapy
- Patients with Zollinger-Ellison syndrome (high-dose PPI required)
| Maintenance Therapy | |
|---|---|
| Drug Class | Agent and Dose |
| Proton pump inhibitors (preferred) | Omeprazole 20 mg, Lansoprazole 30 mg, Rabeprazole 20 mg, or Pantoprazole 40 mg PO once daily (empty stomach) |
| Histamine-2 receptor antagonists (alternative) | Famotidine 20 mg, Nizatidine 150 mg, or Cimetidine 400 mg PO once daily at night |
Prevention of NSAID-Induced Ulcers
Patients requiring long-term NSAIDs should be risk-stratified. High-risk features include: age >65 years, prior PUD or GI bleeding, concurrent use of anticoagulants, corticosteroids, or selective serotonin reuptake inhibitors, high-dose or multiple NSAIDs, and active H. pylori infection.
| Prevention Strategy | Drug / Dose | Evidence Summary |
|---|---|---|
| PPI co-therapy (first-line) | PPI standard dose once daily | Reduces endoscopic duodenal ulcer risk (RR 0.44, 95% CI 0.26–0.74) and gastric ulcer risk (RR 0.40, 95% CI 0.32–0.51); network meta-analysis confirms PPI and vonoprazan as most effective agents for ulcer recurrence prevention in NSAID users with prior ulcer history[4] |
| Misoprostol (alternative) | 200 µg PO QID (with food) | RCT: ulcer rate 1.6% (misoprostol) vs. 16% (sucralfate) in NSAID users (difference 14.4%, 95% CI 10.4–19.5%; p<0.001)[5]; GI side effects (diarrhea, cramping) limit tolerability; absolutely contraindicated in pregnancy |
| COX-2 selective inhibitors | Lowest effective dose | Preferred over non-selective NSAIDs in patients with prior GI events; reduces but does not eliminate GI risk; benefit negated by concurrent aspirin use |
| H. pylori eradication | Treat if positive (see above) | Eradication reduces baseline ulcer risk but is insufficient alone in ongoing NSAID users — PPI co-therapy must be continued |
| Sucralfate | Not recommended for this indication | Inferior to PPIs and misoprostol for prevention of NSAID-induced gastric ulcers |
Management of Upper Gastrointestinal Bleeding from Peptic Ulcer
When peptic ulcer disease presents with acute upper gastrointestinal bleeding (UGIB), the management priorities are: risk stratification, resuscitation, and urgent endoscopy. The 2021 ACG Clinical Guideline on UGIB provides the following guidance:[6]
- Risk stratification: The Glasgow-Blatchford score (GBS) is recommended to identify very-low-risk patients (GBS 0–1) who may be discharged safely with outpatient follow-up
- Transfusion threshold: Red blood cell transfusion is suggested at hemoglobin ≤7 g/dL (restrictive strategy)
- Pre-endoscopy PPI: IV PPI should be given while awaiting endoscopy to downstage high-risk lesions; this does not replace endoscopic therapy
- Promotility agent: Intravenous erythromycin 250 mg infused 30–90 minutes before endoscopy improves mucosal visualization and reduces the need for repeat endoscopy
- Endoscopy timing: Esophagogastroduodenoscopy within 24 hours of presentation for all hospitalized patients with UGIB
- Endoscopic hemostasis: Recommended for ulcers with active spurting or oozing and nonbleeding visible vessels; epinephrine injection must always be combined with a secondary hemostatic modality (thermal or mechanical) — epinephrine monotherapy alone is not recommended
- PPI after endoscopy: High-dose PPI therapy (≥80 mg/day) is recommended for ≥3 days after endoscopic hemostasis — either continuously (80 mg IV bolus then 8 mg/h infusion for 72 h) or intermittently (40 mg IV every 6–12 h for 72 h), followed by twice-daily oral PPI for 2 weeks
Potassium-Competitive Acid Blockers (PCABs)
Vonoprazan is the first approved PCAB and provides faster, more potent, and more sustained acid suppression than conventional PPIs regardless of CYP2C19 metabolizer phenotype, without the need for meal-timed dosing. A pivotal US/Europe phase 3 RCT (PHALCON-HP) showed vonoprazan triple therapy (vonoprazan 20 mg BID + amoxicillin 1 g BID + clarithromycin 500 mg BID × 14 days) and vonoprazan dual therapy (vonoprazan 20 mg BID + amoxicillin 1 g TID × 14 days) were both noninferior to lansoprazole-based triple therapy in the overall population, with intention-to-treat eradication rates of 84.7%, 78.5%, and 78.8% respectively; vonoprazan dual therapy was superior for clarithromycin-resistant strains (70% vs 32%, p<0.0001).[7]
Special Populations
Elderly Patients
Elderly patients are at disproportionately high risk for PUD complications due to higher NSAID and antiplatelet use, attenuated mucosal defenses, and polypharmacy. PPI co-therapy should be strongly considered in all elderly patients receiving NSAIDs or aspirin. Bismuth-containing regimens should be used with caution in patients with impaired renal function given systemic bismuth absorption.
Pregnancy
Misoprostol is absolutely contraindicated in pregnancy due to uterotonic and abortifacient effects. PPIs (omeprazole, pantoprazole) and famotidine are acceptable when clinically required. For H. pylori eradication, treatment should be deferred until after delivery when possible. If urgent, a 7-day regimen of PPI + amoxicillin + metronidazole is accepted in the second and third trimesters; tetracycline and bismuth-containing regimens are contraindicated in pregnancy.[8]
Patients on Aspirin or Anticoagulation
In patients on low-dose aspirin who develop a peptic ulcer bleed, aspirin should be restarted within 3–7 days after hemostasis is secured. Discontinuation of aspirin in high-cardiovascular-risk patients is associated with a significantly increased risk of all-cause mortality. Long-term PPI co-therapy is mandatory when aspirin or anticoagulation must be continued.
Zollinger-Ellison Syndrome
Zollinger-Ellison syndrome (ZES) is caused by a gastrinoma of the pancreas or duodenum leading to hypergastrinemia and recurrent or refractory peptic ulcers. High-dose PPI (often 2–3 times the standard dose, given twice daily) is required. All patients should be screened for multiple endocrine neoplasia type 1 (MEN1). Surgical resection of the gastrinoma is the only potentially curative treatment.
Contraindicated Medications
Bleeding peptic ulcer is considered an absolute contraindication to the use of the following medications:
Guidelines and Resources
| Organization | Guideline | Year |
|---|---|---|
| American College of Gastroenterology (ACG) | ACG Clinical Guideline: Treatment of Helicobacter pylori Infection | 2024 |
| American College of Gastroenterology (ACG) | ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding | 2021 |
| American Gastroenterological Association (AGA) | AGA Clinical Practice Update on the Management of Refractory Helicobacter pylori Infection: Expert Review | 2021 |
| American College of Gastroenterology (ACG) | ACG and CAG Clinical Guideline: Management of Dyspepsia | 2017 |
| American College of Cardiology Foundation / ACG / American Heart Association (ACCF/ACG/AHA) | Expert Consensus Document on Reducing the Gastrointestinal Risks of Antiplatelet Therapy and NSAID Use | 2008 |
| American Society for Gastrointestinal Endoscopy (ASGE) | The Role of Endoscopy in the Management of Patients with Peptic Ulcer Disease | 2010 |
| European Helicobacter and Microbiota Study Group (EHMSG) | Maastricht VI/Florence Consensus Report on the Management of H. pylori Infection | 2022 |
| World Society of Emergency Surgery (WSES) | Guidelines for Management of Perforated and Bleeding Peptic Ulcers | 2020 |
- American College of Gastroenterology (ACG) – Guidelines for the management of dyspepsia.[9]
- American Society for Gastrointestinal Endoscopy (ASGE) – The role of endoscopy in dyspepsia.[10]
- American Society for Gastrointestinal Endoscopy (ASGE) – The role of endoscopy in gastroduodenal obstruction and gastroparesis.[11]
- American College of Cardiology Foundation/ACG/American Heart Association (ACCF/ACG/AHA) – Reducing the gastrointestinal risks of antiplatelet therapy and NSAID use.[12]
- The European Helicobacter Study Group (EHSG) – Maastricht IV/Florence Consensus Report.[13]
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Chey WD, Howden CW, Moss SF, Morgan DR, Greer KB, Grover S, Shah SC (2024). "ACG Clinical Guideline: Treatment of Helicobacter pylori Infection". Am J Gastroenterol. 119 (9): 1730–1753. doi:10.14309/ajg.0000000000002968. PMID 39177539 Check
|pmid=value (help). - ↑ Shah SC, Iyer PG, Moss SF (2021). "AGA Clinical Practice Update on the Management of Refractory Helicobacter pylori Infection: Expert Review". Gastroenterology. 160 (5): 1831–1841. doi:10.1053/j.gastro.2021.01.055. PMID 33600772 Check
|pmid=value (help). - ↑ Cisneros-Garza LE, González-Moreno EI, Martínez-Vázquez SE, Torres-Flores E, Flores-Gaxiola A, Pérez-Pérez GI, Noble-Lugo A (2025). "Good clinical practice recommendations for proton pump inhibitor prescription and deprescription: A review by experts from the AMG". Rev Gastroenterol Mex (Engl Ed). doi:10.1016/j.rgmxen.2025.01.001.
- ↑ Alhazzani W, Hoth M, Mekary R, Barkun AN (2025). "Proton pump inhibitors for the prevention of non-steroidal anti-inflammatory drug-induced ulcers and dyspepsia". Cochrane Database Syst Rev. doi:10.1002/14651858.CD006543.pub4. PMID 40337979 Check
|pmid=value (help). - ↑ Agrawal NM, Roth S, Graham DY, White RH, Germain B, Brown JA, Stromatt SC (1991). "Misoprostol compared with sucralfate in the prevention of nonsteroidal anti-inflammatory drug-induced gastric ulcer: a randomized, controlled trial". Ann Intern Med. 115 (3): 195–200. doi:10.7326/0003-4819-115-3-195. PMID 1858048.
- ↑ Laine L, Barkun AN, Saltzman JR, Martel M, Leontiadis GI (2021). "ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding". Am J Gastroenterol. 116 (5): 899–917. doi:10.14309/ajg.0000000000001245. PMID 33929377 Check
|pmid=value (help). - ↑ Chey WD, Mégraud F, Laine L, López LJ, Hunt BJ, Howden CW (2022). "Vonoprazan Triple and Dual Therapy for Helicobacter pylori Infection in the United States and Europe: Randomized Clinical Trial". Gastroenterology. 163 (3): 608–619. doi:10.1053/j.gastro.2022.05.055. PMID 35679950 Check
|pmid=value (help). - ↑ Raina A, Tanner N, Sharda S, Klair T, Tanner C (2023). "Peptic Ulcer Disease and H. pylori Infection: Common Questions and Answers". Am Fam Physician. 107 (2): 165–172. PMID 36697482 Check
|pmid=value (help). - ↑ Talley NJ, Vakil N, Practice Parameters Committee of the American College of G (2005). "Guidelines for the management of dyspepsia". Am J Gastroenterol. 100 (10): 2324–2337. doi:10.1111/j.1572-0241.2005.00225.x. ISSN 0002-9270. PMID 16181387. Vancouver style error: initials (help)
- ↑ Ikenberry SO, Harrison ME, Lichtenstein D, Dominitz JA, Anderson MA, Jagannath SB, Banerjee S, Cash BD, Fanelli RD, Gan SI, Shen B, Van Guilder T, Lee KK, Baron TH, ASGE Standards of Practice C (2007). "The role of endoscopy in dyspepsia". Gastrointest Endosc. 66 (6): 1071–1075. doi:10.1016/j.gie.2007.07.007. ISSN 0016-5107. PMID 18028927. Vancouver style error: initials (help)
- ↑ ASGE Standards of Practice C, Fukami N, Anderson MA, Khan K, Harrison ME, Appalaneni V, Ben-Menachem T, Decker GA, Fanelli RD, Fisher L, Ikenberry SO, Jain R, Jue TL, Krinsky ML, Maple JT, Sharaf RN, Dominitz JA (2011). "The role of endoscopy in gastroduodenal obstruction and gastroparesis". Gastrointest Endosc. 74 (1): 13–21. doi:10.1016/j.gie.2010.12.003. ISSN 1097-6779. PMID 21704805. Vancouver style error: initials (help)
- ↑ Bhatt DL, Scheiman J, Abraham NS, Antman EM, Chan F, Furberg CD, Johnson DA, Mahaffey KW, Quigley EM, American College of Cardiology Foundation Task Force on Clinical Expert Consensus D (2008). "ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use". Circulation. 118 (18): 1894–1909. doi:10.1161/CIRCULATIONAHA.108.191087. ISSN 1524-4539. PMID 18836135. Vancouver style error: initials (help)
- ↑ Malfertheiner P, Megraud F, O'Morain CA, Atherton J, Axon A, Bazzoli F, Gensini GF, Gisbert JP, Graham DY, Rokkas T, El-Omar EM, Kuipers EJ, European Helicobacter Study G (2012). "Management of Helicobacter pylori infection--the Maastricht IV/Florence Consensus Report". Gut. 61 (5): 646–664. doi:10.1136/gutjnl-2012-302084. ISSN 1468-3288. PMID 22491499. Vancouver style error: initials (help)