Skip to Main Content

Chapter 39: Upper Gastrointestinal Disorders

Patients with NSAID-induced ulcers are more likely to have which of the following? Select all that apply.

a. Superficial ulcer depth

b. A duodenal ulcer

c. Stress-related mucosal bleeding

d. Damage to the gastric mucosa

Answer d is correct. NSAID-induced ulcers typically develop in the gastric mucosa.

Answer a is incorrect. Superficial ulcer depth is common with Helicobacter pylori–induced ulcers.

Answer b is incorrect. Ulcers caused by H. pylori are more common in the duodenum than the stomach.

Answer c is incorrect. Stress-related mucosal bleeding is associated with a major stressful event (mechanical ventilation, trauma, burns, surgery, organ failure, or sepsis).

GT is a 59-year-old man with a documented NSAID-induced ulcer, who is Helicobacter pylori negative. He needs to continue taking an NSAID for severe osteoarthritis. Which is the preferred medication for treating NSAID-induced ulcer? Select all that apply.

a. Lansoprazole

b. Misoprostol

c. Ranitidine

d. Sucralfate

Answer a is correct. A PPI is the agent of choice if the NSAID must be continued in the presence of ulcer disease. If a patient tests positive for H. pylori, treatment is recommended.

Answer b is incorrect. Misoprostol is indicated for the prevention of NSAID-induced gastric ulcers.

Answer c is incorrect. H2-receptor antagonists have been shown to prevent only duodenal ulcers and therefore should not be recommended for prophylaxis of gastric ulcers.

Answer d is incorrect. Sucralfate has not been shown to be effective in preventing or treating NSAID-related ulcers.

TJ is a 43-year-old man with epigastric pain and recently diagnosed with a duodenal ulcer. A urea breath test confirmed H. pylori. The patient denies any allergies to medications. What is recommended as primary therapy for H. pylori?

a. PPI + metronidazole + levofloxacin

b. PPI + metronidazole + clarithromycin

c. PPI + amoxicillin + clarithromycin

d. PPI + metronidazole + bismuth + tetracycline

Answer c is correct. The recommended primary therapy for H. pylori infection includes a PPI, clarithromycin, and amoxicillin (clarithromycin-based triple therapy).

Answer a is incorrect. Levofloxacin-based triple therapy has been used outside the United States, but typically it is ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.