Gastric and Duodenal Ulceration Flashcards
If duodenal and gastric ulcers are not cause by NSAID use, what are they likely caused by?
H. pylori.
What should be confirmed before starting treatment for gastric or duodenal ulceration?
H. pylori infection.
What is the initial, one-week therapy which is used for the eradication of H. pylori?
Triple therapy with a PPI, clarithromycin and either amoxicillin or metronidazole.
What are the disadvantages of two-week triple therapy and two-week dual therapy for H. pylori eradication?
Two-week triple therapy is associated with higher side effects and lower compliance. Two-week dual therapy produces lower eradication rates.
What is the first step to be taken when a patient presents with an NSAID-induced ulcer?
The NSAID should be withdrawn.
What factors may increase a patient’s risk of developing an NSAID-induced ulcer?
Those aged over 65 years, those with a history of GI ulceration, other GI complications, serious comorbidities (CVD, diabetes, renal or hepatic impairment).
In patients at risk of GI ulceration with NSAID use, what other drugs can be given to reduce the risk?
PPI is first choice. H2 receptor antagonists or misoprostol can be considered as alternatives.
What may limit the dose of misoprostol, used for gastroprotection in NSAID use?
Colic and diarrhoea.
Give some examples of drugs which chelate and form ulcer-protecting complexes, used in gastric and duodenal ulceration.
Sucralfate, peptobismol, triopotassium, dicitratobismuthate.
Give some examples of H2 receptor antagonists.
Ranitidine, famotidine, cimetidine, nizatidine.
How do H2 antagonists’ work?
Reduce gastric acid output through histamine H2-receptor blockade.
Give some examples of PPIs.
Lansoprazole, omeprazole, rabeprazole.
How do PPIs work?
Inhibit gastric acid secretion by blocking the hydrogen pump of the gastric parietal cells.
What is one of the main risks associated with sucralfate use?
Bezoar formation - the risk of indigestible material accumulating in the GIT.
Due to the risk of bezoar formation, in which patient groups should sucralfate be used with caution?
The seriously ill, patients receiving enteral feeds, those with delayed gastric emptying.
