•The need for aspirin and NSAIDs should be carefully assessed in patients with a history of peptic ulcer disease. NSAIDs, including aspirin, increase the risk of bleeding in patients with prior peptic ulcer disease. In patients treated for H. pylori, eradication of infection should be confirmed four or more weeks after the completion of therapy.
•Maintenance antisecretory therapy should be limited to high-risk subgroups of patients with peptic ulcer disease. These include individuals with any one of the following:
–Refractory peptic ulcer
–H. pylori-negative, NSAID-negative ulcer disease
–Giant (>2 cm) ulcer and age >50 years or multiple comorbidities
–Failure of H. pylori eradication, including rescue therapies
–Frequently recurrent peptic ulcers (>2 documented recurrences a year)
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