GI

1. First-Line Medical Therapies (Highest Priority)

Proton Pump Inhibitors (PPIs)

Omeprazole (Losec)

Dose: 20\text{ mg} orally in the morning.

Effect: Reduces gastric acid production up to 99\% (most potent acid suppressor).

H. pylori Eradication (Specific Treatment)

Regimen: Combination antimicrobial therapy.

Drug 1: Metronidazole (Flagyl)

Drug 2: Amoxicillin OR Tetracycline

2. Second-Line Medical Therapies (Medium Priority)

H_2 Receptor Blockers

Cimetidine (Tagamet)

Dose: 800\text{ mg} at bedtime.

Side Effects (~5% incidence):

Anti-androgenic: Impotence, gynecomastia, oligospermia.

CNS: Confusion (high doses, crosses blood-brain barrier).

Gastric: Risk of gastric carcinoma.

Ranitidine (Zantac)

Dose: 150\text{ mg} twice daily.

Famotidine (Antodine)

Dose: 40\text{ mg} at bedtime.

Antacids

Formulation: Aluminum Hydroxide Gel + Magnesium Oxide.

Effect: Fast, temporary symptomatic pain relief (does not heal the underlying ulcer).

3. Conservative & Lifestyle Measures (Base Priority)

Primary Goal: Reduce gastric acidity to allow mucosal healing.

Physical & Mental Rest: Reduces stress-induced acid secretion.

Dietary Modifications:

Frequent, small meals.

Avoid irritant foods.

Milk Note: Use with caution/sparingly. Although milk temporarily neutralizes acid, it triggers a secondary rebound of hydrochloric acid (\text{HCl}) secretion.

Substance Avoidance: Stop smoking, coffee, tea, and alcohol.