30 Questions
Which of the following is a main culprit of upper GI complications?
Gastric acid
What is the characteristic size of erosions in Peptic Ulcer Disease (PUD)?
Greater than 5 mm
Which of the following is a common cause of Peptic Ulcer Disease (PUD)?
H. pylori infection
What is the annual affected population percentage by Peptic Ulcer Disease (PUD)?
0.1-0.3%
Which demographic group has a higher mortality rate related to PUD?
Patients over 65
What is the lifetime prevalence of Peptic Ulcer Disease (PUD)?
5-10%
Which type of mucosal damage results in impaired quality of life, work loss, and high-cost medical care?
Stress-related mucosal damage
What has declined in relation to Peptic Ulcer Disease (PUD) in the US?
Mortality
Which condition has shown an increase in GI hemorrhage readmission rates?
Peptic Ulcer Disease (PUD)
What are the two commonly grouped etiologies of Peptic Ulcer Disease (PUD)?
H. pylori-positive and NSAID-induced
What is the major side effect of sucralfate?
Constipation
Which medication is contraindicated in pregnancy?
Misoprostol
What is the potential drawback of long-term use of bismuth preparations?
Potential for bismuth toxicity
Which type of antacids causes constipation?
Aluminum-containing antacids
When should eradication of H. pylori be confirmed in individuals with peptic ulcer disease?
Within 14 days of treatment completion
What is the recommended treatment for Zollinger-Ellison Syndrome (ZES)?
Proton pump inhibitors and H2 receptor antagonists
What is the mechanism of action of prostaglandins like misoprostol in peptic ulcer disease?
Moderately inhibits acid secretion and enhances mucosal defense
What is the drawback of sucralfate in terms of dosing?
Multiple daily doses necessary, large tablet size, must be separated from meals to prevent interacting with concomitant medications (fluoroquinolones)
What is the effect of bismuth preparations on stool or tongue color?
Black color to stool or tongue
What should be assessed in all patients who fail therapy for peptic ulcer disease?
Medication adherence
Which factor does not affect H. pylori infection rates?
Gender
What is the risk factor for developing gastric ulcers in 30-50% of users?
Chronic use of NSAIDs
By how much does H. pylori infection increase the risk of gastrointestinal bleeds?
5-7 times
What effect may H. pylori eradication have on symptoms of gastroesophageal reflux disease (GERD)?
Worsen symptoms
What is a complication of gastric ulcers?
Obstruction
What is included in the treatment for gastric ulcers?
Antimicrobial therapy with acid suppression therapy
What testing should be done in all NSAID-induced ulcers?
Testing for H. pylori
For prevention of NSAID-related ulcers, which strategy is recommended?
Using NSAIDs with PPI or misoprostol
What is the recommended treatment for idiopathic ulcers?
Following guidelines for NSAID-induced PUD
What has been seen to be equally effective for treating idiopathic ulcers?
Famotidine 40 mg daily
Study Notes
- H. pylori infection rates are higher in Black and Hispanic Americans compared to non-Hispanic white Americans.
- Gender and smoking status do not affect H. pylori infection rates.
- Chronic use of non-steroidal anti-inflammatory drugs (NSAIDs), including low dose aspirin, increases the risk of developing gastric ulcers in 30-50% of users.
- H. pylori infection increases the risk of gastrointestinal (GI) bleeds by 3-7 times.
- H. pylori eradication may worsen symptoms of gastroesophageal reflux disease (GERD) but is necessary due to the known risk of gastric cancer.
- NSAIDs cause gastric mucosal damage both locally and systemically.
- Complications from gastric ulcers include bleeding, perforation, and obstruction, with the highest mortality in patients with uncontrolled bleeding or re-bleeding events.
- Treatment for gastric ulcers includes antimicrobial therapy with acid suppression therapy to eradicate H. pylori and relieve symptoms, as well as lifestyle modifications such as stress reduction and smoking cessation.
- Non-pharmacological therapy includes probiotics to limit H. pylori colonization and increase eradication rates, and surgical intervention is typically only done in emergent situations.
- Testing for H. pylori should be done in all NSAID-induced ulcers, and treatment includes discontinuing NSAIDs and starting acid suppression therapy, or continuing NSAID use with a COX-2 selective and PPI or misoprostol.
- For prevention of NSAID-related ulcers, strategies include COX-2 selective NSAIDs with PPI, COX-2 selective NSAIDs alone, non-selective NSAIDs with PPI, and medical co-therapy with misoprostol.
- Idiopathic ulcers are not commonly diagnosed but may be increasing in prevalence, and treatment follows the guidelines for NSAID-induced PUD.
- Famotidine 40 mg daily and lansoprazole 30 mg daily have been seen to be equally effective for treating idiopathic ulcers, and long-term maintenance may be required in some cases.
Test your knowledge of the pathophysiologic mechanisms, causes, treatment options, complications, diagnosis, and patient-specific treatment plans for Peptic Ulcer Disease (PUD). This quiz covers the pharmacotherapy of H. pylori-caused and NSAID-caused PUD.
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