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Old 05-19-2013
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Default Gastroenterology q3

A 44-year-old woman complains of 6 months of epi-gastric pain that is worst between meals. She also reports symptoms of heartburn. The pain is typically relieved by over-the-counter antacid medications. She comes to the clinic after noting her stools darkening. She has no signif-icant past medical history and takes no medications. Her physical examination is normal except for diffuse mid-epigastric pain. Her stools are heme positive. She undergoes EGD, which demonstrates a well-circumscribed 2-cm duodenal ulcer that is positive for H. pylori. Which of the following is recommended initial therapy given these findings?

A. Lansoprazole plus clarithromycin plus amoxicillin for 14 days
B. Pantoprazole plus amoxicillin for 21 days
C. Pantoprazole plus clarithromycin for 14 days
D. Omeprazole plus bismuth plus tetracycline plus metronidazole for 14 days
E. Omeprazole plus metronidazole plus clarithromycin for 7 days
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Old 05-19-2013
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Originally Posted by cingulate.gyrus View Post
A 44-year-old woman complains of 6 months of epi-gastric pain that is worst between meals. She also reports symptoms of heartburn. The pain is typically relieved by over-the-counter antacid medications. She comes to the clinic after noting her stools darkening. She has no signif-icant past medical history and takes no medications. Her physical examination is normal except for diffuse mid-epigastric pain. Her stools are heme positive. She undergoes EGD, which demonstrates a well-circumscribed 2-cm duodenal ulcer that is positive for H. pylori. Which of the following is recommended initial therapy given these findings?

A. Lansoprazole plus clarithromycin plus amoxicillin for 14 days
B. Pantoprazole plus amoxicillin for 21 days
C. Pantoprazole plus clarithromycin for 14 days
D. Omeprazole plus bismuth plus tetracycline plus metronidazole for 14 days
E. Omeprazole plus metronidazole plus clarithromycin for 7 days
A is the preferred regimen as per CDC, MTB3 and USMLe in general. in case of resistance OR not improving you can pick option E...

Tetracycline is seldom used.. we have better Tetracyclines with better safety profile.
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Old 05-19-2013
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Originally Posted by XpaezX View Post
A is the preferred regimen as per CDC, MTB3 and USMLe in general. in case of resistance OR not improving you can pick option E...

Tetracycline is seldom used.. we have better Tetracyclines with better safety profile.

The answer is A.

H. pylori should be eradicated in patients with documented peptic ulcer disease no matter the number of episodes, severity, presence of confound-ing factors (e.g., NSAID ingestion), or symptomatic status. Documented eradication of H. pylori is associated with substantially lower recurrence rates and symptom improve-ment. Treating patients with GERD who require long-term acid reduction therapy and the role of H. pylori eradication to prevent gastric cancer are controversial.

Fourteen-day regimens are most effective. Shorter duration of therapy with current agents available has high recurrence rates. Dual-therapy regimens are not recommended because of eradica-tion rates of less than 80%. A number of combinations are available . Triple-therapy regimens (one antacid plus two antibiotics) for 14 days have an eradication rate of 8590%.

Antibiotic resistance is the most common cause of failure to eradicate in compli-ant patients. Unfortunately, there is no currently available test for H. pylori sensitivity to direct therapy. Quadruple therapy should be reserved for patients with failure to eradicate after an effective initial course.

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Old 05-19-2013
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1st. PCA or PCM

2nd PBMT or PMT or PMA
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