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Every duodenal ulcer (DU) associated with H. pylori (HP) infection should be treated with HP eradication therapy. The recommended HP eradication therapy is a short-term triple
therapy for 7 or 10 days’ duration, consisting of a protonpump-inhibitor (PPI), or ranitidine bismuth citrate (RBC) and two
antibiotics selected among clarithromycin, metronidazole (or tinidazole), and amoxicillin.
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If possible, any treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) should be discontinued. If continuation of NSAID
treatment is necessary, concomitant therapy with a PPI is necessary.
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HP-negative DUs are treated with one oral standard dose of PPI, although some patients will need higher doses to have the
DU healed.
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Whereas in uncomplicated DU the disappearance of symptoms is a good surrogate marker for DU healing, the healing of bleeding
DU must be documented by endoscopy.
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The role of surgery is to treat complications of DU, such as perforation or uncontrollable bleeding, not to reduce gastric
acid secretion.
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