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This document discusses peptic ulcer disease (PUD), including risk factors, pathophysiology, diagnosis, and treatment. Some key points: - H. pylori infection and NSAID use are the leading causes of PUD. H. pylori infection is present in 60% of Americans over age 60. - Diagnosis involves testing for H. pylori (stool antigen, urea breath, serology), and endoscopy if high risk or symptoms persist after treatment. - Treatment for H. pylori-associated PUD is triple therapy (PPI plus two antibiotics) for 14 days. NSAID-associated PUD is treated with PPIs and prostag

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Peptic Ulcer Disease Ramona Carter-Burdine M.D. UTMB Galveston, Tx
Learning Objectives ,[object Object],[object Object],[object Object],[object Object],[object Object]
Disease Prevalence ,[object Object],[object Object],[object Object],[object Object],[object Object]
Definition ,[object Object],[object Object]
Differentiating gastric from peptic ulcer disease ,[object Object],[object Object],[object Object]
Case Presentation ,[object Object],[object Object],[object Object],[object Object]
Initial Differential Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mr. Jones HPI ,[object Object],[object Object]
Signs and Symptoms of PUD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical Pearls ,[object Object],[object Object]
Mr Jones History ,[object Object],[object Object],[object Object],[object Object]
Common Risk Factors for Gastric Mucosal Disruption ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pathophysiology ,[object Object]
NSAIDs ,[object Object],[object Object],[object Object],[object Object],[object Object]
Individual NSAID Risk ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
History of Ulcer Treatment ,[object Object],[object Object],[object Object]
History of Ulcer Treatment Cont’d ,[object Object],[object Object],[object Object],[object Object]
Discovery of Helicobacter pylori ,[object Object],“Robin Warren and Barry Marshall's work on ulcers was pioneering” Story from BBC NEWS: http://news.bbc.co.uk/go/pr/fr/-/2/hi/asia-pacific/4307826.stm Published: 2005/10/04 10:39:09 GMT © BBC MMVII
H. pylori ,[object Object],[object Object],[object Object],[object Object],[object Object]
H. pylori ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Differentiating between H. pylori and NSAID-induced ulcer ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Other Disease Conditions Associated with PUD ,[object Object],[object Object]
Mr. Jones Physical Exam ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Physical Exam Findings ,[object Object],[object Object],[object Object],[object Object],[object Object]
If Mr. Jones Hemoccult is Positive ,[object Object],[object Object],[object Object]
Lab Studies to Evaluate PUD ,[object Object],[object Object],[object Object],[object Object],[object Object]
Principles in Selecting H. pylori Test ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
H. Pylori Serology Antibody Test ,[object Object],[object Object],[object Object]
When is a Serology Test Useful? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
H. Pylori Stool Antigen (HpSa) Test ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Urea Breath Test ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Breath Test Compared to HpSa ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Imaging Studies ,[object Object],[object Object],[object Object],[object Object],[object Object]
Endoscopy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Rapid Urease Test and Histopathology ,[object Object],[object Object],[object Object]
Mr. Jones Prior Ulcer History ,[object Object],[object Object]
Answer ,[object Object],[object Object],[object Object]
Moving on to Treatment Options……….
Over The Counter Remedies ,[object Object],[object Object],[object Object],[object Object]
Over the Counter Remedies cont’d ,[object Object],[object Object]
H2-Blockers ,[object Object],[object Object],[object Object]
Side Effects of Cimetidine/Tagamet ® ,[object Object],[object Object],[object Object],[object Object]
Proton Pump Inhibitors ,[object Object],[object Object],[object Object],[object Object],[object Object]
Other Pharmacotherapy Agents ,[object Object],[object Object]
H. Pylori Triple Therapy Treatment ,[object Object],[object Object],[object Object],[object Object]
H Pylori Treatment http://www.drugdigest.org/DD/Comparison/NewComparison/0,10621,550540-21,00.html Cure Rate Side Effect Rating 81-92% low-medium Prevpak 80-85% medium-high Helidac + H2 blocker Combination Products 80-90% medium Amoxicillin + Metronidazole + PPI 80-90% medium-low Amoxicillin + Clarithromycin + PPI 80-90% medium Clarithromycin + Metronidazole + PPI Three Drug Regimens
H. Pylori Therapy cont’d ,[object Object],[object Object],[object Object]
PUD Complications ,[object Object],[object Object],[object Object],[object Object]
Initial Treatment Plan in the Absence of High Risk Symptoms ,[object Object],[object Object],[object Object],[object Object],[object Object]
Final Recommendations ,[object Object],[object Object],[object Object],[object Object]
Medical Legal Pitfalls ,[object Object],[object Object],[object Object],[object Object],[object Object]
Alternate Scenarios of Mr. Jones Case ,[object Object],[object Object]
Alternate Scenarios to Mr. Jones Case ,[object Object],[object Object]
Summary ,[object Object],[object Object],[object Object],[object Object],[object Object]
References ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
References cont’d ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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Peptic Ulcer Disease.Ppt.Fmdrl

  • 1. Peptic Ulcer Disease Ramona Carter-Burdine M.D. UTMB Galveston, Tx
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  • 38. Moving on to Treatment Options……….
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  • 46. H Pylori Treatment http://www.drugdigest.org/DD/Comparison/NewComparison/0,10621,550540-21,00.html Cure Rate Side Effect Rating 81-92% low-medium Prevpak 80-85% medium-high Helidac + H2 blocker Combination Products 80-90% medium Amoxicillin + Metronidazole + PPI 80-90% medium-low Amoxicillin + Clarithromycin + PPI 80-90% medium Clarithromycin + Metronidazole + PPI Three Drug Regimens
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