24 Questions
What is the duration of treatment with proton pump inhibitors for gastric ulcers?
6-8 weeks
What is the effect of histamine on gastric secretion?
It stimulates acid secretion
What is the difference in dosing between oral and IV administration of proton pump inhibitors?
There is no difference
Which of the following proton pump inhibitors is only available orally in the United States?
Rabeprazole
What is the primary mechanism of action of antacids?
Neutralizing gastric acid
What is the duration of action of H2 blockers?
6-20 hours
What is the effect of proton pump inhibitors on pepsin secretion?
Decrease pepsin secretion
What is the typical duration of treatment with proton pump inhibitors for GERD?
Long-term maintenance
What is the least common complication of peptic ulcers?
Gastric outlet obstruction
What is the site of penetration of GUs?
Into the left hepatic lobe
What is the mechanism of action of proton pump inhibitors?
Inhibition of H+,K+-ATPase
What is the primary advantage of endoscopy over radiographic examination?
Ability to visualize small lesions
What is a common symptom of gastric outlet obstruction?
Early satiety
What is the role of proton pump inhibitors in H.pylori eradication regimens?
Acid suppression
What is the site of duodenal ulcer penetration?
Posteriorly into the pancreas
What is the advantage of proton pump inhibitors over H2 blockers?
Greater efficacy
What is the primary mechanism by which misoprostol inhibits acid secretion?
Decreasing the production of cyclic AMP in parietal cells
What is a common side effect of magnesium hydroxide antacids?
Diarrhea
What is the main advantage of nonabsorbable antacids over absorbable antacids?
They have fewer systemic adverse effects
Which of the following patients is at high risk of developing NSAID-induced mucosal injury?
Older patient with a history of ulcer or ulcer complication
What is the primary mechanism by which antacids relieve symptoms of peptic ulcers?
Neutralizing stomach acid
What is the main reason why antacids should be taken 5 to 7 times a day?
To maintain a constant level of antacid in the stomach
What is the potential side effect of chronic use of aluminum hydroxide antacids?
Phosphate depletion
Why are magnesium preparations used with caution in patients with renal disease?
Because small amounts of magnesium are absorbed
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)
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.
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