GI: Peptic ulceration Flashcards
Initial treatment of H.pylori consists of a one-week triple-therapy regimen of
PPI, clarithromycin and either amoxicillin or metronidazole.
When would the initial treatment of H.pylori consits of one-week of PPI, clarithromycin and amoxicilln?
if a patient has been treated with metronidazole for other infections, a regimen containing a proton pump inhibitor, amoxicillin and clarithromycin is preferred for initial therapy.
When would the initial treatment of H.pylori consits of one-week of PPI, metronidazole and amoxicillin?
IF the patient has recently recieved macrolide treatment for other infections.
Why are two-week dual therapy regimens using a proton pump inhibitor and a single antibacterial not recommended despite being licensed?
Low eradication rates
What other nitroimidazole drug can be used instead of metro?
Tinidazole.
What can be used to treat H.pylori which has already resisted treatment with triple therapy of PPI, clarithromycin and either metro or amoxicillin?
A two-week regimen compromising a proton pump inhibitor plus tripotassium dicitratobismuthate, plus tetracycline, plus metronidazole.
Alternatively, the patient can be referred for endoscopy and treatment can be based on the results of culture and specificity testing.
How is H.pylori tested for?
13C-Urea breath test kits are available for the diagnosis of H.pylori infection.
How do H.pylori breath tests work?
The test involves the collection of breath samples before and after ingestion of an oral solution of 13C-Ureal the samples are sent for analysis by an appropriate laboratory.
When should H.pylori tests not be performed?
The test should not be performed within 4 weeks of treatment with an antibacterial or within 2 weeks of treatment with an antisecretory drug.
In those at risk of ulceration with non-selective NSAID treatment, what can be considered for protection against gastric and duodenal ulcers? (3)
PPI or H2-antagonist like ranititdine at twice the usual dose or misoprostol.
What may limit the use of misoprostol in those at risk of ulceration receiving treatment with non-selective NSAIDs?
Misoprotol use may be limited by colic and diarrhoea.
Misoprostol use is most appropriate for who?
Those who are frail or very elderly from whom NSAIDs cannot be withdawn.
In a patient who has developed an ulcer, if the NSAID can be discontinued, what treatment produces the most rapid healing?
In a patient who has developed an ulcer, if the NSAID can be discontinued, a proton pump inhibitor usually produces the most rapid healing; alternatively, the ulcer can be treated with a H2-receptor antagonist or misoprostol. On healing, patients should be tested for H. pylori and given eradication therapy if H. pylori is present.
