1. Any patient with worrying symptoms such as dysphagia or weight loss, or those found to be anaemic should be referred for endoscopy.
  2. Any patient with severe symptoms persisting for two weeks or more who is aged over 45 should be referred for endoscopy.
  3. Any patient who because of extreme age or infirmity would constitute an increased endoscopic risk should be treated empirically, including the use of proton pump inhibitors.
  4. Any patient whose symptoms are mild or infrequent should be offered lifestyle advice (WAS) and antacids or alginates.
  5. Patients under the age of 45 who do rot respond to the above measures, or whose symptoms are severe should be given a 2-3 month trial of an H2 receptor blocker or prokinetic drug.
  6. Patients who do not respond to 5, or who relapse after discontinuation should be referred for endoscopy.
WAS ALARMS
W eight
A lcohol
S moking
 A larms
L oss of weight
A ge
R ecurrent problem
M elaena
S wallowing problem

Management of peptic ulcer
Ulcer maintenance therapy