Prevention

Stop NSAIDs ^a
If patients need to continue, consider: 

• topical NSAIDs ^b  
• ibuprofen ^b  at the lowest possible dose ^b  
• a COX-2 inhibitor such as rofecoxib ^a or celecoxib ^b  
• adding in misoprostol ^a or a regular proton pump inhibitor ^a
• H. pylori eradication therapy for infected patients without ulcers ^a

For patients with peptic ulcers

• Give H. pylori eradication therapy to infected patients ^a  based on microbial sensitivities if available ^b
  • using triple therapy  ^b 
    • a proton-pump inhibitor plus any 2 of amoxicillin, clarithromycin or nitroimidazole ^b  
    • a bismuth compound plus nitroimidazole plus tetracycline ^b  
  • or quadruple therapy ^a
  • Consider adding 
    • probiotics e.g Lactobacillus GG ^a
    • cetraxate for smokers ^a
• Continue giving proton-pump inhibitors for at least 8 weeks ^a

• Continue endoscopic ligation ^a  or sclerotherapy ^a  until varices are obliterated

• beta-blockers ^a 
• or isosorbide mononitrate slow-release 50 mg po daily ^a  
  • There is no clear benefit from combining beta-blockers and isosorbide mononitrate ^d  
• or octreotide (50 micrograms subcutaneously twice daily for 6 months)