Peptic ulcer disease / GI bleeding history

PUD/prior GI-bleed history mainly changes ANALGESIC choice — not antibiotics or local anesthetic. Risk depends on how active, recent and severe the ulcer disease is, so stratify rather than treating every history the same. • AVOID NSAIDs (contraindicated per BNF/NICE CKS and the ibuprofen SmPC §4.3) if: active peptic ulcer or GI bleeding; prior GI bleed/perforation on an NSAID; or ≥2 distinct proven episodes of ulceration/bleeding. • A single, remote, HEALED, uncomplicated ulcer (especially H. pylori-eradicated) is a CAUTION, not an automatic lifelong bar — acetaminophen is still preferred first-line, but a short lowest-dose NSAID course with gastroprotection can be acceptable after weighing risk with the physician. Core rule: acetaminophen-first; NSAIDs risk-stratified; also check GI-bleed risk multipliers (anticoagulants, antiplatelets, corticosteroids, SSRIs).