Block 1: PUD Flashcards
What are the common forms of PU?
- H pylori
- NSAID-induced
- Stress related
What are co-factors that may cause PU?
- Cigarette smoking
- Alcohol
- Gastric acid hypersecretion
- Medication nonadherence
What is H pylori?
- G- bacteria that resides between gastric mucus layer and surface epithelial
- Ability to buffer gastric pH -> urease production
- Strong adherence and motility
- Inflammation and mucosal injury from cytotoxin production (60% of strains)
What are the complications of forming an ulcer?
- Upper GI bleeeding
- Perforation (most concerning -> peritonitis -> sepsis)
- Obstruction
What are the sx of PUD
- Asymptomatic
- Epigastric pain/N
- Bloating, belching, v/hematemesis, melena
What are the general diagnostic testing for PUD?
- CBC
- Fecal occult blood
- Upper endoscopy
What are the H pylori diagnostic testing for PUD?
- Endoscopic Biopsy & Culture
- Non-endoscopic:
* Antibody detection (not for past infections)
* Urea breath test
* Fecal antigen
What are the goals to treat PUD?
- Relieve ulcer pain
- Heal the ulcer
- Prevetn ulcer recurrence -> H pylori eradication
- Reduce ulcer-related complications
How do you eracicate H. pylori?
Bismuth quadruple therapy for 10-14 days:
1. PPI or H2RA Q-BID
2. Bismuth subsalicylate 525 mg QID
3. Metronidazole 250-500 mg QID
4. Tetracycline 500 mg QID
Why don’t you give clarithomycin to children? Why is it not in quad therapy?
Effects bone and teeth
Resistance
Patient presents with a Penicillin allergy and H pylori? What quad med should you not give?
Amoxicillin
What are the indication of treating H pylori?
- Diagnosed with PUD from infection
- Dyspepsia, GERD, iron deficiecy anemia, long term aspirin, NSAIDs
What is the initial treatment for H pylori?
What are example of combo product for H pylori?
Adherence is an issue with infection.
Add on PPI for quad therapy
What are probiotics?
Living microbial species that can include anti-inflammatory and anti-oxidative mechanisms that may improve bowel microecology and general health
What are the types of probiotics?
Lactobacillus and Bifidobacterium
What are the benefits of the limitations of using Probiotics in H pylori infection?
- Limit H pylori colonization when taking antibiotics -> increase eradication rates
- Doesn’t eradicate H pyloir infection
How should you select the best H pylori regimen?
- Avoiding tetracyclines in children
- DDI/ADR
- Alcohol with metronidazole
- Non-adherence check
- PPI preferred over H2RA, no preference in which PPI is used
What are the counseling points of H pylori regimen?
- Do not drink alcoholic beverages while taking metronidazole
- Antibiotics may decrease the effectiveness of birth control
- Bismuth salicylate may cause a change in stool color
What are good predicotors of H pylori eradication?
- Antimicrobial resistance
- Duration of therapy
- Med adherence
- Genetic polymorphism
What do you do in signs of antimicrobial resistance?
- Dual antibiotics regimens utilized to decrease issue
- Substitution of similar antibiotics within a class not recommended
What do you do in initial tx failure?
Salvage tx:
1. Use antibiotics that were not used during initial therapy or from another infection
2. Guided antibiotic resistance testing
3. Use of an extended duration of tx (14 days)
4. Add bismuth
5. Penicillin allergy, consider allergy skin test to determine with amoxicillin can be used
Describe the MOA of NSAIDs?
What is the tx for NSAID induced ulcer?
- Stop the NSAID, if able to:
* Switch to Tynelol or selective COX2 inhibitor
* Unable to, PPI is first line or misoprostol
* PPI should be continued for 12 weeks if continuing the NSAID or 8 weeks if NSAID is stopped - PPI is preferred agent due to more rapid symptom relief and ulcer healing compared to sucralfate and H2RAs