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  • Image not available. Patients with peptic ulcer disease (PUD) should reduce psychological stress, cigarette smoking, and nonsteroidal antiinflammatory drug (NSAID) use and avoid foods and beverages that exacerbate ulcer symptoms.
  • Image not available. Eradication is recommended for all Helicobacter pylori (H. pylori)–positive patients with an active ulcer, a documented history of a prior ulcer, or a history of ulcer-related complications.
  • Image not available. The selection of an H. pylori eradication regimen should be based on efficacy, safety, antibiotic resistance, cost, and the likelihood of medication adherence. Treatment should be initiated with a proton pump inhibitor (PPI)–based three-drug regimen. If a second course of H. pylori therapy is required, the regimen should contain different antibiotics.
  • Image not available. PPI cotherapy reduces the risk of NSAID-related gastric and duodenal ulcers and is at least as effective as recommended dosages of misoprostol and superior to the histamine-2 receptor antagonists (H2RA).
  • Image not available. Standard PPI dosages and a nonselective NSAID are as effective as a selective cyclooxygenase-2 (COX-2) inhibitor in reducing the risk of NSAID-induced ulcers and upper gastrointestinal (GI) complications.
  • Image not available. The eradication of H. pylori improves clinical outcomes and decreases the use of healthcare resources when compared with conventional antisecretory therapy. The cost effectiveness of misoprostol cotherapy is greatest for patients with the highest risk for GI complications. Cotherapy with PPIs and NSAIDs or selective COX-2 inhibitors is cost effective even in low-risk patients especially if the least costly PPI is used.
  • Image not available. Patients with PUD, especially those receiving H. pylori eradication or misoprostol cotherapy, require patient education regarding their disease and drug treatment to successfully achieve a positive therapeutic outcome.
  • Image not available. The recommended treatment for severe peptic ulcer bleeding after appropriate endoscopic treatment is the intravenous administration of a PPI loading dose followed by a 72-hour continuous infusion with a goal of maintaining an intragastric pH of 6 or greater.
  • Image not available. Critically ill patients at the highest risk of developing stress-related mucosal bleeding (SRMB) who require prophylactic drug therapy include those with respiratory failure on mechanical ventilation or those with coagulopathy.
  • Image not available. There are limited data to support the selection of a PPI over an intravenous H2RA for SRMB prophylaxis. The decision should be based upon appropriate individual patient characteristics (e.g., nothing by mouth, presence of nasogastric tube, renal failure).

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Upon completion of the chapter, the reader will be able to:

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  • 1. Compare and contrast Helicobacter pylori (H. pylori)-associated ulcers, nonsteroidal antiinflammatory drug (NSAID)-induced ulcers, Zollinger-Ellison syndrome (ZES) and stress-related mucosal damage (SRMD) as it relates to etiologic and risk factors, pathophysiologic mechanisms, signs and symptoms, clinical course, and prognosis.
  • 2. Discuss the advantages and disadvantages of the endoscopic and nonendoscopic tests as they relate to the diagnosis of H. pylori and the posttreatment confirmation of H. pylori eradication.
  • 3. Discuss the issues, controversies, and recommendations related to H. pylori testing and treating of asymptomatic patients or patients with uninvestigated or nonulcer dyspepsia, an active or documented prior ulcer, ulcer-related gastrointestinal (GI) complications, MALT lymphoma, or H. pylori–associated ...

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