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Peptic Ulcer Disease (PUD) (signs and symptoms (weight loss, dull, burning…
Peptic Ulcer Disease (PUD)
etiology and pathophysiology
sore that develops on the mucosal lining of the esophagus, stomach, or small intestine
risk factors: NSAID overuse, heavy alcohol use, physiological stress, smoking, infected with
H. pylori
, concurrent use of corticosteroids or anticoagulants, age > 60yo, obesity
classification is based on the location of the ulcer (duodenal vs. gastric)
signs and symptoms
weight loss
dull, burning stomach pain
excessive belching
nausea/vomiting
. feeling of fullness or bloating
fatigue
treatment options
pharmacological
first-line
proton pump inhibitors (PPIs)
omeprazole (Prilosec), lansoprazole (Prevacid), esomeprazole (Nexium), dexlansoprazole (Dexilent), pantoprazole (Protonix)
AEs: reduced absorption of vitamins
MOA: irreversibly block the gastric H+/K+-ATPase, inhibiting gastric acid secretion
evaluate for
C. difficile
in pts receiving PPIs who have diarrhea that is not improving
duration of action: 24-72 hours
misoprostol (Cytotec)
CIs: women of childbearing age
does not reduce dyspepsia
AEs: diarrhea
poorly tolerated (requires multiple doses per day)
second-line
sucralfate (Carafate)
MOA: forms a complex with positively-charged proteins to locally protect gastric lining from peptic acid, pepsin, and bile salts
AEs: hyperglycemia, constipation
use with caution in pts with CKD (increased risk of aluminum accumulation and toxicity)
if
H. pylori
infection is present
triple therapy
PPI BID + amoxicillin 1g BID + clarithromycin for 7 days
quadruple therapy
PPI BID + bismuth + metronidazole + tetracycline x10d
non-pharmacological
smoking cessation
stress management
decrease NSAID use
avoid foods that may exacerbate reflux symptoms
treatment goals
eradication of
H. pylori
if present
reduce NSAID use or administer a COX-2 selective NSAID (e.g. celecoxib)
prevention of disease progression and complications
alleviation of acute symptoms
diagnostic criteria and testing
upper endoscopy
urea breath test (to identify
H. pylori
infections)
tissue biopsy
fecal antigen test
monitoring and follow-up
eradication of
H. pylori
after 4 weeks of therapy
check for signs of antibiotic resistance
alarm symptoms
: blood in stool, difficulty swallowing, dizziness, anemia