PUD

Question 1

How would you confirm H pylori?

Answer 1

C-13 urea breath test- stop PPI 2 weeks before

Serology- ab to H pylori. Can’t confirm eradication

Stool antigen testing

Frequently identified on endoscopy biopsy

Question 2

How would you eradicate H pylori?

Answer 2

Give for 7 days

PPI BD (e.g. omeprazole 20mg BD)

Amoxicillin 1g BD

Clari 500mg BD (or metronidazole 400mg TDS)

Question 3

How would you eradicate H pylori in a patient who is penicillin allergic?

Answer 3

PPI + clari 500mg BD + metronidazole 400mg BD

Question 4

How would you treat a patient who has had unsuccessful H pylori eradication?

Answer 4

Suggests poor compliance or abx resistance

PPI + amoxicillin + clari/metronidazole (whatever not used)

Question 5

How would you treat a patient who has had unsuccessful H pylori eradication who is penicillin allergic?

Answer 5

PPI + bismuth + metronidazole + tetracycline

Question 6

What is the most common SE of H pylori eradication?

Answer 6

Diarrhoea

Question 7

Who are at highest risk of NSAID-associated ulcers?

Answer 7

Elderly
Previous GI bleed
Significant comorbidities

Question 8

What significantly increases the risk of GI SEs from NSAIDS?

Answer 8

Use with low-dose aspirin

Question 9

How would you mx a patient requiring an NSAID? (E.g. RA)

Answer 9

Prescribe PPI for protection, or H2RA or misoprostol

Always try and use NSAIDs with lowest risk GI toxicity (ibuprofen)

Question 10

Which NSAID has lowest risk GI protection?

Answer 10

Ibuprofen