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GIHEP Medicine - PUD (i) (Clinical presentation (Dyspepsia (epigastric…

- - - - ammonia neutralises gastric acid - forms protective cloud around organism - enables it to penetrate gastric mucus layer
    - - 2nd leading cause of cancer related mortality worldwide
      - H pylori = strongest risk factor
      - only a v small no of those infected progress
      - if found tx as is technically a carcinogen
- - - - early satiety
      - bloating
      - indigestion
      - anorexia
      - nausea
      - vomiting
      - epigastric pain shortly after eating
      - weight loss
- - - - start qd, progress to bd
      - take 30 mins before meals
      - work better than H2 blockers...
        
        gastric acid secreted via proton (H-K) pump
        
        for pump to activate, 1 of 3 basal Rs must be stimed (CCK-B, H2, or ACh) -> increased cAMP -> increased intracellular Ca
        
        PPIs block all 3 Rs, H2 blockers only block 1
  - - - PPI bd x 1wk
      - amoxicillin 1g bd x 2wks
      - clarithromycin 500mg bd x 2wk
      - other antibiotics can be switched in: tetracyclines, bismuth
    - - only if refractory to PPI
      - vagus branches stim acid production