Lecture 64 Flashcards
Peptic Ulcer Disease (Hebenstreit)
contributing factors to PUD
H pylori infection
NSAID use
gastric acid and pepsin
cigarette smoking
critical illness
dietary fators
types of PUD
H pylori induced
NSAID induced
stress induced
H pylori-induced PUD factors
condition: chronic
Site of Damage: Duodenum > stomach
Intragastric pH: more dependent
Symptoms: epigastric pain
Ulcer depth: superficial
GI bleeding: less severe
NSAID-induced PUD factors
condition: chronic
Site of Damage: Stomach > duodenum
Intragastric pH: less dependent
Symptoms: often asymptomatic
Ulcer depth: deep
GI bleeding: more severe
stress-induced PUD factors
condition: acute
Site of Damage: Stomach > Duodenum
Intragastric pH: less dependent
Symptoms: asymptomatic
Ulcer depth: most superficial
GI bleeding: more severe
complications of PUD
GI bleeding
GI perforation
GI obstruction (life threatening)
signs and symptoms of PUD
epigastric pain
belching, heartburn
weight loss
nausea
bloating, abdominal fullness
early satiety
H Pylori-induced PUD treatment
several different regimen options
typically acid suppressor with 2-3 antibiotics
helpful to determine if patients has had any recent antibiotic exposure to predict resistance
treatment options for H Pylori Induced PUD
Bismuth –> quadruple therapy
Clarithromycin –> triple, concomitant, sequentia, hybrid
Levofloxacin –> triple, quadruple (LOAD), sequential
Rifabutin –> triple
Vonoprazan –> dual, triple
Bismuth quadruple therapy
preferred regimen
contains 1. PPI BID 2. BSS 525mg QID 3. Metronidazole 250-500mg QID 4. Tetracycline 500mg QID
comes in convenience packaging - Helidac and Pyleria
duration: 10 to 14 days
Education: do not recommend in children under age of 12
Helidac
contains metronidazole 250mg, tetracycline 500mg, BSS 262.4mg
must also take PPI BID
14 blister cells
Pyleria
contains Bismuth subcitrate potassium 140mg, metronidazole 125mg, tetracycline 125
3-1 packaging
3 caps QID for 10 days
clarithromycin triple therapy
contains PPI BID, clarithromycin 500mg BID, Amoxicillin 1g BID or Metronidazole 500mg BID
Duration - 14 days
Education - not preferred in the US due to macrolide resistance
clarithromycin concomitant therapy
contains PPI BID, clarithromycin 250-500mg BID, Amoxicillin 1G BID, Metronidazole 250-500mg BID
duration: 10 to 14 days
education: another first line therapy; also known as non-bismuth quad
clarithromycin sequential therapy
contains PPI BID (days 1-10), Amoxicillin 1G BID (days 1-5), Metronidazole 250-500mg BID (days 6-10), clarithromycin 250-500mg BID (days 6-10)
duration - 10 days
clarithromycin hybrid therapy
contains PPI BID (days 1-14), amoxicillin 1G BID (days 1-14), Metronidazole 250-500mg BID (days 7-14), clarithromycin 250-500mg BID (days 7-14)
duration: 14 days
levofloxacin triple therapy
contains - PPI BID, Levofloxain 500mg QD, Amoxicilin 1G BIB
Duration: 10-14 days
Levofloxacin quadruple therapy (LOAD)
contains Levofloxacin 250mg QD, PPI (like omeprazole) at high dose QD, Nitazoxanide 500mg BID, Doxycycline 100mg QD
Duration: 7-10 days
Levofloxacin sequential therapy
contains PPI BID (days 1-10), amoxicillin 1G BID (days 1-5), levofloxacin 500mg QD (days 6-10), metronidazole 500mg BID (days 6-10)
duration - 10 days
rifabutin triple therapy
contains omeprazole 40mg q8h, amoxicillin 1g q8h, ribabutin 50mg q8h
duration: 14 days
education: no determined place in therapy, typically used as a salvage therapy currently
vonoprazan dual therapy
contains vonoprazan 20mg BID and amoxicillin 1G q8h
duration: q4 days
vonoprazan triple therapy
contains vonoprazan 20mg BID, amoxicillin 1g BID, and clarithromycin 500mg BID
duration: 14 days
importance of PPI in H Pylori PUD
backbone due to antisecretory effects enhancing antibiotic activity
shown to produce higher eradication rates
H2RAs should not be used unless PPI is not tolerated
do not use beyond 2 weeks
PPI dosing in H Pylori induced PUD
omeprazole - 20mg
pantoprazole - 40mg
esomeprazole - 20 to 40mg
lansoprazole - 30mg
