gastric and duodenal ulceration Flashcards
Which drugs are used to treat gastric and duodenal ulcers ?
PPI
H2 receptor antagonists
Misoprostol
Sucralfate
What test are recommended for H.Pylori?
The urea (13C) breath test, Stool Helicobacter Antigen Test (SAT), or laboratory-based serology where its performance has been locally validated, are recommended for the diagnosis of gastro-duodenal infection with H. pylori. PHE advise that the urea (13C) breath test and SAT should not be performed within 2 weeks of treatment with a proton pump inhibitor or within 4 weeks of antibacterial treatment, as this can lead to false negatives.
What is first line treatment for H.pylori in non penicillin allergic patients ?
Oral first line for 7 days:
A proton pump inhibitor, plus amoxicillin, and either clarithromycin or metronidazole (treatment choice should take into account previous treatment with clarithromycin or metronidazole).
What is the 2nd line treatment for H.Pylori in non penicillin allergy ?
Oral second line for 7 days (if ongoing symptoms after first line treatment):
A proton pump inhibitor, plus amoxicillin, and either clarithromycin or metronidazole (whichever was not used first line).
Oral alternative second line for 7 days (for patients who have received previous treatment with clarithromycin and metronidazole):
A proton pump inhibitor, plus amoxicillin, and tetracycline [unlicensed] (or, if a tetracycline cannot be used, levofloxacin [unlicensed]).
What is the 3rd line treatment for H.Pylori in non penicillin allergy ?
Oral third line for 10 days on specialist advice only in line with PHE Guidance:
A proton pump inhibitor, plus bismuth subsalicylate [unlicensed], and either 2 antibacterials from those mentioned above not previously used, or rifabutin [unlicensed], or furazolidone [unlicensed].
What is the 1st line treatment for H. Pylori in penicillin allergy ?
Oral first line for 7 days:
A proton pump inhibitor, plus clarithromycin, and metronidazole.
Oral alternative first line for 7 days (for patients previously treated with clarithromycin):
A proton pump inhibitor, plus bismuth subsalicylate [unlicensed], plus metronidazole, and tetracycline [unlicensed].
What is the 2nd line treatment for H. Pylori in penicillin allergy ?
Oral second line for 7 days (if ongoing symptoms after first line treatment in patients who have not received previous treatment with a fluoroquinolone):
A proton pump inhibitor, plus metronidazole, and levofloxacin [unlicensed].
Oral alternative second line for 7 days (in patients who have received previous treatment with a fluoroquinolone):
A proton pump inhibitor, plus bismuth subsalicylate [unlicensed], plus metronidazole, and tetracycline [unlicensed].
What is the treatment for NSAID induced ulcers ?
withdraw NSAID if possible
PPI or alternatives H2 antagonist/misoprostol
Test for H.pylori on healing : if positive eradication therapy
What are the risk factors that increase GI complications when using NSAIDs ?
65+
previous history
taking certain medicines
significant co-morbidities: liver, kidney, heart disease and diabetes
What is the prophylaxis for NSAID induced ulcers for those who are at risk ?
PPI or alternative is H2 antagonists/misoprostol
for those who have 3 or more risk factors or previous history of upper GI bleeding: PPI with Cox-2 selective NSAID ( but they have higher risk of CV events)
