Clinical recommendation	Evidence rating	References
Prompt upper endoscopy is recommended for patients with peptic ulcers who are older than 55 years, those who have alarm symptoms, and those with ulcers that do not respond to treatment.	A	1,19
In patients with peptic ulcer disease, Helicobacter pylori should be eradicated to assist in healing and to reduce the risk of gastric and duodenal ulcer recurrence.	A	1,8
In patients with peptic ulcers, proton pump inhibitors provide acid suppression, healing rates, and symptom relief superior to other antisecretory therapies.	A	23
Patients with bleeding peptic ulcers should be given a proton pump inhibitor to reduce transfusion requirements, need for surgery, and duration of hospitalization. H. pylori testing should be performed and eradication therapy prescribed if results are positive.	A	32,34
In patients with perforated ulcers, coexisting H. pylori infection should be eradicated to minimize the need for long-term antisecretory therapy and further surgical intervention.	C	25,37