gastric and duodenal ulceration Flashcards Preview

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Flashcards in gastric and duodenal ulceration Deck (10)
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1

Which drugs are used to treat gastric and duodenal ulcers ?

PPI
H2 receptor antagonists
Misoprostol
Sucralfate

2

What test are recommended for H.Pylori?

The urea (13C) breath test, Stool Helicobacter Antigen Test (SAT), or laboratory-based serology where its performance has been locally validated, are recommended for the diagnosis of gastro-duodenal infection with H. pylori. PHE advise that the urea (13C) breath test and SAT should not be performed within 2 weeks of treatment with a proton pump inhibitor or within 4 weeks of antibacterial treatment, as this can lead to false negatives.

3

What is first line treatment for H.pylori in non penicillin allergic patients ?

Oral first line for 7 days:
A proton pump inhibitor, plus amoxicillin, and either clarithromycin or metronidazole (treatment choice should take into account previous treatment with clarithromycin or metronidazole).

4

What is the 2nd line treatment for H.Pylori in non penicillin allergy ?

Oral second line for 7 days (if ongoing symptoms after first line treatment):
A proton pump inhibitor, plus amoxicillin, and either clarithromycin or metronidazole (whichever was not used first line).
Oral alternative second line for 7 days (for patients who have received previous treatment with clarithromycin and metronidazole):
A proton pump inhibitor, plus amoxicillin, and tetracycline [unlicensed] (or, if a tetracycline cannot be used, levofloxacin [unlicensed]).

5

What is the 3rd line treatment for H.Pylori in non penicillin allergy ?

Oral third line for 10 days on specialist advice only in line with PHE Guidance:
A proton pump inhibitor, plus bismuth subsalicylate [unlicensed], and either 2 antibacterials from those mentioned above not previously used, or rifabutin [unlicensed], or furazolidone [unlicensed].

6

What is the 1st line treatment for H. Pylori in penicillin allergy ?

Oral first line for 7 days:
A proton pump inhibitor, plus clarithromycin, and metronidazole.
Oral alternative first line for 7 days (for patients previously treated with clarithromycin):
A proton pump inhibitor, plus bismuth subsalicylate [unlicensed], plus metronidazole, and tetracycline [unlicensed].

7

What is the 2nd line treatment for H. Pylori in penicillin allergy ?

Oral second line for 7 days (if ongoing symptoms after first line treatment in patients who have not received previous treatment with a fluoroquinolone):
A proton pump inhibitor, plus metronidazole, and levofloxacin [unlicensed].
Oral alternative second line for 7 days (in patients who have received previous treatment with a fluoroquinolone):
A proton pump inhibitor, plus bismuth subsalicylate [unlicensed], plus metronidazole, and tetracycline [unlicensed].

8

What is the treatment for NSAID induced ulcers ?

withdraw NSAID if possible
PPI or alternatives H2 antagonist/misoprostol
Test for H.pylori on healing : if positive eradication therapy

9

What are the risk factors that increase GI complications when using NSAIDs ?

65+
previous history
taking certain medicines
significant co-morbidities: liver, kidney, heart disease and diabetes

10

What is the prophylaxis for NSAID induced ulcers for those who are at risk ?

PPI or alternative is H2 antagonists/misoprostol
for those who have 3 or more risk factors or previous history of upper GI bleeding: PPI with Cox-2 selective NSAID ( but they have higher risk of CV events)