skip to main content

Clean-Based Duodenal Ulcer — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

ModerateGastroenterologyClean-Based Duodenal UlcerRACP Adult Medicine

A 65-year-old man on dual antiplatelet therapy (aspirin + clopidogrel) after recent coronary stenting presents with UGIB. OGD shows a 1.5 cm duodenal ulcer with a clean base (Forrest III). No active bleeding or stigmata of recent haemorrhage. H. pylori urease test is positive. What is the most appropriate endoscopic management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — No endoscopic therapy required — treat H. pylori and PPI

Forrest III (clean-based ulcer) has very low rebleeding risk (<5%) and does NOT require endoscopic therapy. Medical management: high-dose IV PPI (omeprazole 80 mg bolus then 8 mg/hr infusion is for higher-risk ulcers — Forrest Ia/Ib/IIa). H. pylori eradication (triple therapy) is essential. Discuss antiplatelet therapy with cardiology — aspirin is usually continued; clopidogrel is held briefly if safe.

Reference: GESA – 2024 – Peptic Ulcer Bleeding; BSG 2024