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Questions and Answers
What is the duration of treatment with proton pump inhibitors for gastric ulcers?
What is the duration of treatment with proton pump inhibitors for gastric ulcers?
What is the effect of histamine on gastric secretion?
What is the effect of histamine on gastric secretion?
What is the difference in dosing between oral and IV administration of proton pump inhibitors?
What is the difference in dosing between oral and IV administration of proton pump inhibitors?
Which of the following proton pump inhibitors is only available orally in the United States?
Which of the following proton pump inhibitors is only available orally in the United States?
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What is the primary mechanism of action of antacids?
What is the primary mechanism of action of antacids?
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What is the duration of action of H2 blockers?
What is the duration of action of H2 blockers?
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What is the effect of proton pump inhibitors on pepsin secretion?
What is the effect of proton pump inhibitors on pepsin secretion?
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What is the typical duration of treatment with proton pump inhibitors for GERD?
What is the typical duration of treatment with proton pump inhibitors for GERD?
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What is the least common complication of peptic ulcers?
What is the least common complication of peptic ulcers?
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What is the site of penetration of GUs?
What is the site of penetration of GUs?
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What is the mechanism of action of proton pump inhibitors?
What is the mechanism of action of proton pump inhibitors?
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What is the primary advantage of endoscopy over radiographic examination?
What is the primary advantage of endoscopy over radiographic examination?
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What is a common symptom of gastric outlet obstruction?
What is a common symptom of gastric outlet obstruction?
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What is the role of proton pump inhibitors in H.pylori eradication regimens?
What is the role of proton pump inhibitors in H.pylori eradication regimens?
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What is the site of duodenal ulcer penetration?
What is the site of duodenal ulcer penetration?
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What is the advantage of proton pump inhibitors over H2 blockers?
What is the advantage of proton pump inhibitors over H2 blockers?
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What is the primary mechanism by which misoprostol inhibits acid secretion?
What is the primary mechanism by which misoprostol inhibits acid secretion?
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What is a common side effect of magnesium hydroxide antacids?
What is a common side effect of magnesium hydroxide antacids?
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What is the main advantage of nonabsorbable antacids over absorbable antacids?
What is the main advantage of nonabsorbable antacids over absorbable antacids?
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Which of the following patients is at high risk of developing NSAID-induced mucosal injury?
Which of the following patients is at high risk of developing NSAID-induced mucosal injury?
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What is the primary mechanism by which antacids relieve symptoms of peptic ulcers?
What is the primary mechanism by which antacids relieve symptoms of peptic ulcers?
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What is the main reason why antacids should be taken 5 to 7 times a day?
What is the main reason why antacids should be taken 5 to 7 times a day?
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What is the potential side effect of chronic use of aluminum hydroxide antacids?
What is the potential side effect of chronic use of aluminum hydroxide antacids?
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Why are magnesium preparations used with caution in patients with renal disease?
Why are magnesium preparations used with caution in patients with renal disease?
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Study Notes
Ulcer Complications
- DUs tend to penetrate posteriorly into the pancreas, leading to pancreatitis
- GUs tend to penetrate into the left hepatic lobe
- Gastrocolic fistulas associated with GUs have also been described
Gastric Outlet Obstruction
- Least common ulcer-related complication, occurring in 1–2% of patients
- Relative obstruction secondary to ulcer-related inflammation and edema in the peripyloric region
- Fixed, mechanical obstruction secondary to scar formation in the peripyloric areas requires endoscopic or surgical intervention
- Signs and symptoms include:
- New onset of early satiety
- Nausea
- Vomiting
- Increase of postprandial abdominal pain
- Weight loss
Endoscopy
- Most sensitive and specific approach for examining the upper GI tract
- Facilitates direct visualization of the mucosa
- Permits photographic documentation of a mucosal defect
- Allows for tissue biopsy to rule out malignancy or H. pylori
Treatment
Proton Pump Inhibitors
- Potent inhibitors of H+,K+-ATPase
- Completely inhibit acid secretion and have a long duration of action
- Promote ulcer healing and are key components of H. pylori eradication regimens
- Include esomeprazole, lansoprazole, pantoprazole, omeprazole, and rabeprazole
- Available orally and IV, except for omeprazole and rabeprazole, which are only available orally in the US
Dosing
- Uncomplicated duodenal ulcers: omeprazole 20 mg once a day or lansoprazole 30 mg once a day for 4 weeks
- Complicated duodenal ulcers: higher doses (omeprazole 40 mg once a day, lansoprazole 60 mg once a day or 30 mg 2 times a day)
- Gastric ulcers: treatment for 6 to 8 weeks
- Gastritis and GERD: treatment for 8 to 12 weeks, with long-term maintenance for GERD
H2 Blockers
- Competitive inhibitors of histamine at the H2 receptor
- Suppress gastrin-stimulated acid secretion and proportionately reduce gastric juice volume
- Include cimetidine, famotidine, and nizatidine
- Available orally and IV, except for nizatidine, which is only available orally in the US
Antacids
- Neutralize gastric acid and reduce pepsin activity
- Relieve symptoms, promote ulcer healing, and reduce recurrence
- May interfere with absorption of other medications
- Two types: absorbable and nonabsorbable
- Absorbable antacids (e.g. sodium bicarbonate, calcium carbonate): rapid, complete neutralization, but may cause alkalosis
- Nonabsorbable antacids (e.g. aluminum or magnesium hydroxide): fewer systemic adverse effects, preferred
Aluminum Hydroxide
- Relatively safe, commonly used antacid
- May cause phosphate depletion with chronic use
Magnesium Hydroxide
- More effective antacid than aluminum
- May cause diarrhea
- Should be used with caution in patients with renal disease
Prostaglandins
- Certain prostaglandins (e.g. misoprostol) inhibit acid secretion and enhance mucosal defense
- Used to decrease the risk of NSAID-induced mucosal injury
- Common adverse effects: abdominal cramping and diarrhea (30% of patients)
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Description
This quiz covers the use of proton pump inhibitors such as esomeprazole, lansoprazole, and pantoprazole in treating duodenal ulcers, including their dosage and administration. Learn about the different types of proton pump inhibitors and their applications.
