PUD Flashcards
Ulceration of the mucosa anywhere in the GI tract that is exposed to acid and pepsin
Peptic ulcer disease
What are the 2 common forms of PUD?
- Duodenal ulcer
- Gastric ulcer
What is the most common form of PUD?
Duodenal ulcer
What ages do duodenal ulcers usually occur?
Between ages 30-50
What ages are usually diagnosed with Gastric ulcers?
> 60 years
What are the 3 most common types of PUD?
- H. Pylori
- NSAID induced
- Stress related mucosal damage
True or false: cigarette smoking can help ease the pain caused by PUD
False
People who develop PUD tend to be more adversely affected by _____.
Stress
What 4 foods can cause dyspepsia but do not increase the risk of PUD?
- Coffee
- Tea
- Soda
- Spices
What is found in most people with duodenal and gastric ulcers?
H. Pylori
How is H. Pylori primarily spread?
Through fecal to oral route
What is the mechanism for H. Pylori causing PUD?
Catalyzes urea—> ammonia—> erodes mucus barrier—> epithelial damage
What 2 things does H. Pylori produce?
- Cytotoxins
- Mucolytic enzymes
NSAIDs are weak ___ and _______ at gastric pH
Acids; nonionized
What do NSAIDS decrease the production of?
Prostaglandins
Since prostaglandin production is decreased what 3 things can happen?
- Reduction in gastric and mucosal blood flow
- Decreased mucus and bicarbonate secretion
- Decrease cellular replication and repair
NSAID induced PUD is prevalent in what type of patients?
- Pts > 60
- Pts with a prior history of PUD
- Pts taking high dose NSAIDS
Concurrent administration with what 5 drugs can lead to NSAID induced PUD?
- Corticosteroids
- Anticoagulants
- Oral bisphosphonates
- Antiplatelet agents
- SSRIs
NSAID induced ulcers are often ____.
Silent
What is the most ulcernogenic NSAID?
Aspirin
What do symptoms of PUD depend on?
- Ulcer location
- Patient age
Pain does not follow a consistent pattern with which type of ulcer?
Gastric Ulcer
Food often relieves pain with which type of ulcer?
Duodenal ulcer
Pain is more likely to follow a consistent pattern with what type of ulcer?
Duodenal ulcer
Nocturnal epigastric pain is highly suggestive of what kind of ulcer?
Duodenal ulcer
What are the 3 major complications of PUD?
- Bleeding
- Perforation
- Mortality
What is the rapid urease test?
H. Pylori + HP urease —> NH3 + CO2 —> increase pH and color change
What does the serological test detect?
IgG to HP
What 3 tests can be used as an initial screen?
- Serologic
- UBT
- FAT
What therapy is first line therapy of PUD?
Standard Triple Therapy
How long is the first line therapy given for?
10-14 days preferably 14
What do you give a patient as an alternative if they are allergic to penicillin?
Metronidazole
What is the standard triple therapy?
Amoxicillin PLUS Clarithromycin PLUS a PPI
What drug has the highest resistance rates?
Clarithromycin
When is Clarithromycin considered 1st line therapy based on resistance?
If resistance is < 15%. And in patients who have never been exposed to a macrolide antibiotic
What therapy can be used if Clarithromycin cannot be used?
Bismuth- based Quadruple therapy
What drugs are in the bismuth based quadruple therapy?
Tetracycline PLUS metronidazole PLUS bismuth subsalicylate PLUS a PPI
What is used for concomitant therapy?
Clarithromycin PLUS amoxicillin PLUS metronidazole or tinidazole PLUS a PPI
What is used as second line therapy or “salvage therapy”?
- Levofloxacin based triple therapy
- Levofloxacin Sequential therapy
What is included in Levofloxacin based triple therapy?
Amoxicillin PLUS Levofloxacin PLUS PPI
What is included in the Levofloxacin sequential therapy?
Amoxicillin PLUS PPI PLUS Levofloxacin PLUS metronidazole
Rifabutin based triple therapy includes what?
Omeprazole PLUS amoxicillin PLUS rifabutin
How long can you use a PPI for anti-secretory therapy?
2 weeks
What should you use for treatment of H. Pylori negative Ulcers?
H2 antagonists or sucralfate
How long can you use conventional treatment for H. Pylori negative ulcers?
4 weeks
How should you treat NSAID induced ulcers?
- Ideally d/c NSAID
- Treat with standard doses of h2 antagonists, sucralfate, or PPI
If an NSAID MUST be continued what should you do? 2
- Reduce NSAID dose
- Change to APAP or selective COX-2 inhibitors
In addition to a PPI for both
What can be used as maintenance therapy for NSAID induced ulcers?
- PPIs in standard maintenance dose
OR - Misoprostol
What should you caution patients to look out for with PUD
Signs of GI bleeding