H2 -receptor antagonists (e.g., ranitidine or famotidine) are used to block acid secretion and treat ulcer disease Alternatively PPIs (e.g., omeprazole or lansoprazole) can be used and are more effective at decreasing gastric acid secretion than H2 -receptor antagonists PPIs should be used in patients with anemia or who have moderate to severe PUD Potential short-term adverse effects with PPI usage include headache, abdominal pain, diarrhea, nausea, and vomiting When initiating therapy, follow-up is important, as is providing a sufficient quantity so that the child can take the medication until the outpatient visit has occurred Sucralfate (40 to 80 mg/kg/day by mouth every hours) is a sucrose sulfate and aluminum hydroxide salt that creates a gel over the mucosal surface and insulates the gastric mucosa from further damage by acid, pepsin, or bile It is recommended to be given on an empty stomach hour before meals and at bedtime, and not given at the same time as other medications given its ability to bind them Current protocols for first-line therapy for H pylori include a PPI plus two antibiotics (choosing two of the following: amoxicillin, clarithromycin, or metronidazole for 10 to 14 days) Compliance is an important consideration because it is a major determinant of the success of treatment Antibiotic susceptibility testing for clarithromycin is recommended before initial clarithromycin-based triple therapy in areas/populations with a known high resistance rate (>20%) as this will adversely affect eradication rates MALLORY–WEISS TEARS/PROLAPSE GASTROPATHY Mallory–Weiss tears are mucosal lacerations of the distal esophagus and proximal stomach induced by forceful retching Patients typically present with a recent history of repeated vomiting prior to onset of the hematemesis and less frequently, with pain from the tear While the amount of blood can vary, Mallory–Weiss tears usually are self-limited and not require any medical or surgical intervention Upper GI bleeding after retching or vomiting may also be due to prolapse gastropathy, when the stomach prolapses through the lower esophageal sphincter causing mucosal injury Management is generally conservative with antiemetic therapy, PPI, and observation LOWER GI BLEEDING Inflammatory Bowel Disease