GI: PUD

Question 1

Causes of PUD

Answer 1

• Helicobacter pylori
• NSAIDs
• Gastric Acid Hypersecretion
• Impaired duodenal bicarb secretion

Question 2

How does *H. pylori** *cause PUD?

Answer 2

• Breaks down mucus layer
• Inflammatory response
• Direct cellular injury

Question 3

How do NSAIDs cause PUD?

Answer 3

Inhibition of PG synthesis

(PGs stimulate mucous cells to produce mucous, which forms protective coat over surface of stomach)

Question 4

Treatment options for H. pylori

Answer 4

Triple therapy and quadruple therapy: a combo of PPIs and antibiotics +/- bismuth subsalicylate

Question 5

Triple therapy

Answer 5

14 day Tx for H. pylori

• High dose PPI Q12h
• Antibiotics Q12h
  
  • Clarithromycin 500mg AND
  • Amoxicillin 1000mg OR metronidazole 500mg

Triple if not >15% resistance in area.

Question 6

Quadruple Therapy

Answer 6

14 day Tx for H. pylori

• High dose PPI Q12h
• Bismuth subsalicylate 524mg 4x daily
• Antibiotics 4x daily
  
  • Metronidazole 250mg AND
  • Tetracycline 500mg OR doxycycline 100mg Q12h

quadruple if >15% resistance in area.

Question 7

Combo products for *H. pylori *Tx

Answer 7

• Lansoprazole, amoxicillin, clarithromycin (Prevpac)
• Bismuth subcitrate potassium, metronidazole, tetracycline (pylera)

Combos are more expensive than single agents

Question 8

Treatment of NSAID ulcer

Answer 8

• Stop NSAID therapy
• Confirm H. pylori negative
• Start anti-secretory therapy w/H2Bs or PPIs

Faster ulcer healing w/PPIs for 4-6w