Peptic Ulcer Disease

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Presentation Transcript

Peptic Ulcer Disease: 

Peptic Ulcer Disease Brooke Y. Patterson, PharmD, BCPS NU 7080: Advanced Pharmacology Research College of Nursing

Epidemiology: 

Approximately 10% of Americans develop PUD in their lifetime Ulcer-related physician visits have doubled since 1960 Aging population Increased use of NSAIDs Epidemiology

Pathophysiology: 

Duodenal ulcer H. pylori infection (95%) NSAIDS Gastric ulcer NSAIDS H. pylori Pathophysiology

Clinical Presentation: 

Duodenal Ulcer Epigastric pain Possibly worse at night Occurs 1-3 hours postprandial Other symptoms: heartburn, belching, bloated feeling, nausea Gastric ulcer Epigastric pain Made worse by eating Clinical Presentation

Diagnosis-H. pylori: 

Breath Tests and Stool antigen tests Urea breath test 95-100% specificity In-office test (breath) Urea Blood Test Less specific Serologic tests Not reliable—persisting antibodies Endoscopy Culture of organism to determine antibiotic therapy Diagnosis-H. pylori

Goals of Therapy: 

Eliminate causative agent Eliminate H. pylori Discontinue NSAID use Heal gastric erosions Prevent gastric erosions Goals of Therapy

Treatment of H. Pylori: 

ACG guidelines recommend PPI plus at least 2 antibiotics Duration of therapy is 7-14 days 14 days preferred Follow-up testing for eradication High-risk patients Urea breath tests or stool antigen tests At least 4 weeks post-therapy Treatment of H. Pylori

Treatment of NSAID-Induced Ulcers: 

Risk factor modification Discontinue NSAID PPIs Drug of choice Treatment of NSAID-Induced Ulcers

Treatment of NSAID-Induced Ulcers: 

Risk factor modification Discontinue NSAID PPIs Drug of choice Treatment of NSAID-Induced Ulcers

Slide10: 

Drink no longer water, but use a little wine for thy stomach's sake. -Timothy 1:23