Gastric + duodenal ulcers

Question 1

Treatment

Answer 1

PPIs
H2 receptor anatagonists

Question 2

Treatment - other options

Answer 2

Misoprostol
Sucralfate

Question 3

Misoprostol

Answer 3

Teratogenic - avoid in pregnancy
Dose limiting SE:
- Colic
- Diarrhoea (may be severe and require withdrawal)

Question 4

Sucralfate

Answer 4

SE =
Benzoar formation
- 1 hour before meals/1 hour gap between enteral feeds.

Question 4

H.pylori

Answer 4

1 week triple therapy:
PPI (BD) + Clarithomycin + Amoxicillin or Metronidazole

Question 4

Antibiotic choice

Answer 4

Possible combinations = PAC, PAM or PMC

Proton pump inhibitor (BD)

Amoxicillin
- Penicillin allergic give PMC

Clarithromycin
- If pt treated with macrolide with other infection, give PAM

Metronidazole
- If used to treat other infection recently give PAC

Question 5

NSAID induced ulcers

Answer 5

Withdraw NSAID
PPI
- alternative = H2 antagonist or misoprostol
Test for h.pylori on healing
- positive = eradication therapy

Question 6

NSAID induced ulcers - management after

Answer 6

Non-selective NSAID continued = continue PPI or misoprostol

History of upper GI bleed = continue PPI + switch to cox-2 inhibitor

Question 7

Gastric and duodenal ulcers - risk factors

Answer 7

• 65+
• High dose NSAIDs;
• Other drugs that increase the risk of gastro-intestinal adverse-effects (e.g. anticoagulants, corticosteroids, selective serotonin reuptake inhibitors)
• Serious co-morbidity (e.g. cardiovascular disease, hypertension, diabetes, renal or hepatic impairment)
• Heavy smoker
• Excessive alcohol consumption
• Previous adverse reaction to NSAIDs
• Prolonged treatment NSAIDs.

Question 8

At risk

Answer 8

PPI
Alternative = h2 antagonists/misoprostol

Question 9

3+ risk factors

Answer 9

PPI with cox-2 selective NSAID

Question 10

H.pylori tes

Answer 10

13C-urea breath kits
- Do not perform test within 4 weeks of antibacterial OR 2 weeks of treatment with Antisecretory drug