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Chapter 39: Upper Gastrointestinal Disorders

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

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a. Superficial ulcer depth

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b. A duodenal ulcer

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c. Stress-related mucosal bleeding

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d. Damage to the gastric mucosa

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

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

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

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

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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.

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a. Lansoprazole

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b. Misoprostol

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c. Ranitidine

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d. Sucralfate

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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.

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

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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.

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

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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?

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a. PPI + metronidazole + levofloxacin

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b. PPI + metronidazole + clarithromycin

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c. PPI + amoxicillin + clarithromycin

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d. PPI + metronidazole + bismuth + tetracycline

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

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

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