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What is the most common cause of PUD? Other 2 common causes?
H. pylori (95%)
NSAIDs and low-dose ASA
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Whats the main difference in clinical sx that differentiates GERD from PUD?
With PUD, epigastric pn occurs 1-3hrs after meal and MAY be relieved by eating
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What is the most common sign of PUD and when is it the worst (at what timing)?
What are 5 other asso'd sx's?
Most common: Epigastric pn, possibly worse at nite (pn occurs 1-3hrs after eating and may be relieved by eating)
- Asso'd sx:
- Heartburn
- Belching
- Bloated feeling
- Nausea
- Anorexia
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Why must practitioners be willing to treat H. pylori if pt is tested positive?
Its a known carcinogen
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In terms of GI toxicity, name the following:
3 low risk NSAID
1 mod risk NSAID
2 HI risk NSAID
- Low risk NSAID:
- Ibuprofen
- Diclofenac
- Nabumetone
- Mod risk NSAID:
- Naproxen (fyi is best for high CV risk d/t low CV events in studies)
- Hi risk NSAID:
- Piroxicam
- Ketorolac
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What are two MAIN points to get from invasive and non-invasive dx tests for H. pylori (i.e. false negatives, etc)?
1. False negatives may result frm partly tx'd infx with PPI's or H2RA's
2. Pt should d/c antisecretory agents 1-2 wks before test AND wait 4 wks to re-test for eradication
FYI UBT (urea breath test) and stool antigen tests are preferred dx to confirm eradication per ACG
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Per ACG recommendations, whats the recommendation for combo meds (drug classes) for eradication of H. pylori? Preferred days of tx?
PPI + two Abx (Clarithromycin and Amox/Metronidazole)
Metronidazole if PCN-allergy
Days: 14 days preferred
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Per ACG, when is quadruple therapy for H. pylori indicated? (2) What is the regimen?
- Indicated if:
- 1. Pt is allergic/intolerant to Triple therapy
- 2. Failed triple therapy
- Quadruple therapy:
- PPI + (Metronidazole + TCN + Bismuth) (Pylera)
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What are the DOSES of the 4 preferred triple therapy for H. pylori? (HINT: ROLE)
- ROLE
- 1. Rabeprazole 20mg BID + Clarithromycin 500mg BID + Amox 1000mg BID (or Metronidazole 500mg TID)
2. Omeprazole (10, 20, 40mg caps; 20mg OTC tabs) 20mg BID + Clarithromycin 500mg BID + Amox 1000mg BID (or Metronidazole 500mg TID)
3. Lansoprazole (15, 30mg caps) 30mg BID + Clarithromycin 500mg BID + Amox 1000mg BID (or Metronidazole 500mg TID)
4. Esomeprazole (20, 40mg caps) 40mg DAILY + Clarithromycin 500mg BID + Amox 1000mg BID (or Metronidazole 500mg TID)
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What are the doses for the alternative quadruple therapy for H. pylori?
- PPI BID (ROL)
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- Bismuth subsalicylate 525mg (=2 chew tabs) QID
- +
- Metronidazole 500mg TID
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- TCN 500mg QID
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Per ACG, which pt's are considered as "high CV risk"?
Which NSAID is preferred in pt with high CV risk?
High CV risk = pt who require daily low-dose ASA
Preferred NSAID = Naproxen (doesnt appear to inc risk of CV events)
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For healing or tx of ulcers from NSAID use, what is the general preferred tx choices? Which tx is less tolerated? (2)
- 1. PPI
- 2. Misoprostol (Cytotec) 200mcg QID WF (last dose HS) - less tolerated d/t diarrhea, abd cramping, and freq dosing
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If CV risk greatly outweighs GI bleed risk, what NSAID must be avoided at all cost?
Celecoxib
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What is admin instruction for pt taking both ASA and another NSAID (like ibuprofen) and why?
Take ibuprofen 8 hours BEFORE or 30 mins AFTER ASA
d/t inc GI bleed AND may limit cardioprotective efx of ASA
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