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This chapter is a revision of the chapter on Peptic Ulcer Disease in the 8th edition written by Rosemary R. Berardi and Randolph V. Fugit.

  • image 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 Eradication is recommended for all Helicobacter pylori–positive patients, especially those patients with an active ulcer, a documented history of a prior ulcer, or a history of ulcer-related complications.
  • image 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 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 (H2RAs).
  • image 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 GI complications.
  • image 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 The recommended treatment for severe peptic ulcer bleeding after appropriate endoscopic treatment is the IV 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 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 There are limited data to support the selection of a PPI over an IV H2RA for SRMB prophylaxis. The decision should be based on appropriate individual patient characteristics (e.g., nothing by mouth, presence of nasogastric tube, renal failure).

  1. Compare and contrast Helicobacter 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. Describe the advantages and disadvantages of the endoscopic and nonendoscopic tests for the diagnosis of H. pylori and the posttreatment confirmation of H. pylori eradication.

  3. Discuss the most important factors related to the selection of an initial H. pylori eradication regimen.

  4. Recommend the appropriate management of an H. pylori–positive patient with H. pylori–associated initial ulcer, recurrent ulcer, or penicillin allergy given current symptomatology and historical information.

  5. Design a monitoring plan for a patient with an H. pylori–associated ulcer receiving eradication therapy based on patient-specific information and the prescribed drug treatment regimen.

  6. List the factors affecting medication adherence for a patient with an H. pylori–associated ulcer receiving eradication therapy.

  7. Formulate appropriate counseling information to provide a patient with an H. ...

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