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Old 08-17-2011
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GIT Failure of H Pylori Rx, what's next?

Kaplan CK Notes confuses me here
somebody shows up with h/o gastric ulcer (diagnosed previously by endoscopy) and is found to be H-pylori positive for which he is given the triple therapy. he continues to have the symptoms, what is the next best step in management?
1) urea breath test (to ensure eradication)
2) re-endoscopy and biopsy
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Old 08-17-2011
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I remember that it was urea breath test because doing another biopsy would be more invasive and the patient have a previous Endoscopy.
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Old 08-17-2011
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gastric ulcer has 4% for progression to Gastric Ca .. so in refractory cases it would be appropriate to biopsy to rule out gastric Ca .. this is not done for duodenal ulcer
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Old 08-17-2011
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Its urea breath test and see if organism still prersists and continue with tx. Duration and recurrence h/o if long and repeated then endoscopy and biopsy.
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Old 08-17-2011
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Quote:
Originally Posted by amberafzal View Post
Kaplan CK Notes confuses me here
somebody shows up with h/o gastric ulcer (diagnosed previously by endoscopy) and is found to be H-pylori positive for which he is given the triple therapy. he continues to have the symptoms, what is the next best step in management?
1) urea breath test (to ensure eradication)
2) re-endoscopy and biopsy
actually with a history of gastric ulcer you would to biopsy....re testing for urea breath is not indicated since biopsy is the most accurate test and it has to be done anyways to rule out cancer which is associated with gastric ulcer..
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Old 08-17-2011
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1) urea breath test

It can be used to check for response to therapy.
Doing re-endoscopy & biopsy will be a more invasive unnecessary test.
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Old 08-17-2011
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Quote:
Originally Posted by amberafzal View Post
Kaplan CK Notes confuses me here
somebody shows up with h/o gastric ulcer (diagnosed previously by endoscopy) and is found to be H-pylori positive for which he is given the triple therapy. he continues to have the symptoms, what is the next best step in management?
1) urea breath test (to ensure eradication)
2) re-endoscopy and biopsy
can u post the whole question.....because there is likely u missed something of value that would indicate one txt rather than the other
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Old 08-17-2011
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Quote:
Originally Posted by Kais_MD View Post
can u post the whole question.....because there is likely u missed something of value that would indicate one txt rather than the other
the question was as such put to me by another fellow studyin for ck.
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Old 08-30-2011
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this question is in kaplan q bank, gastric ulcer cause by h.pylori treat with triple regimen, if pt came beck with same symptom go for urea breath test, if +ve then change regimen and treat it again

Last edited by satelliteguy; 08-31-2011 at 04:50 AM.
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Old 08-30-2011
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Quote:
Originally Posted by amberafzal View Post
Kaplan CK Notes confuses me here
somebody shows up with h/o gastric ulcer (diagnosed previously by endoscopy) and is found to be H-pylori positive for which he is given the triple therapy. he continues to have the symptoms, what is the next best step in management?
1) urea breath test (to ensure eradication)
2) re-endoscopy and biopsy

In Duodenal ulcer , you do urea breath test to see persistant H.pylori and change therapy to metronidazole and tetracycline.

But, in gastric ulcer ,you do endoscopy and biopsy to rule out cancer .
(refer page 249 MTB step 2CK )
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Old 08-31-2011
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yes i think MTB is right here...because H pylori is a cause of both gastric ulcer as well as gastric CA, and benign ulcer usually responds to triple regimn...n if it is not responding,, it is likely that ulcer is malignant....( n i think urea breath test is not preferable because it will come positive in both cases i.e refactory ulcer n CA) so its better to rule out ca by biopsy, then treat refactory ulcer with changing regimn or quadruple regimn....
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Old 08-31-2011
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main difference btwn in gastric and duodenal ulcer is cause of ulcer, h pylori is most common cause of PU 80-90% but GU 50-70%, so if pt is not responding GU after antibiotics regimen we have to go thru some investigation, initially go thru least invasive as urea breath test, if its +ve then go for endo+biopsy to exclude gastric CA, but in PU if urea breath +ve then change the regimen and treat it, zollinger ellison should also be excluded with serum gastrin level, one would expect to see multiple ulcer or ulcer pr at distal duodenal in pt with ZES.
answer of your question is depend on case scenerio, its next step or (best, accurate, definitive) step
next is urea breath, accurate is endo+biopsy, thru pt symptom we can aslo dx gatric or duodenal ulcer, early pain after eating GU and late pain after eating PU
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