1
Q
Causes of PUD
A
- Helicobacter pylori
- NSAIDs
- Gastric Acid Hypersecretion
- Impaired duodenal bicarb secretion
2
Q
How does *H. pylori** *cause PUD?
A
- Breaks down mucus layer
- Inflammatory response
- Direct cellular injury
3
Q
How do NSAIDs cause PUD?
A
Inhibition of PG synthesis
(PGs stimulate mucous cells to produce mucous, which forms protective coat over surface of stomach)
4
Q
Treatment options for H. pylori
A
Triple therapy and quadruple therapy: a combo of PPIs and antibiotics +/- bismuth subsalicylate
5
Q
Triple therapy
A
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.
6
Q
Quadruple Therapy
A
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.
7
Q
Combo products for *H. pylori *Tx
A
- Lansoprazole, amoxicillin, clarithromycin (Prevpac)
- Bismuth subcitrate potassium, metronidazole, tetracycline (pylera)
Combos are more expensive than single agents
8
Q
Treatment of NSAID ulcer
A
- Stop NSAID therapy
- Confirm H. pylori negative
- Start anti-secretory therapy w/H2Bs or PPIs
Faster ulcer healing w/PPIs for 4-6w
