PEPTIC ULCER DISEASE JOHN R SALTZMAN, MD. Director of Endoscopy Brigham and Women s Hospital Professor of Medicine Harvard Medical School

Size: px
Start display at page:

Download "PEPTIC ULCER DISEASE JOHN R SALTZMAN, MD. Director of Endoscopy Brigham and Women s Hospital Professor of Medicine Harvard Medical School"

Transcription

1 PEPTIC ULCER DISEASE JOHN R SALTZMAN, MD Director of Endoscopy Brigham and Women s Hospital Professor of Medicine Harvard Medical School

2 No disclosures Disclosures

3 Overview Causes of peptic ulcer disease Clinical manifestations Current diagnostic tests Recommended therapies New strategies to treat H. pylori Complications including GI bleeding

4 Peptic ulcer disease Ulcers are defects in gastrointestinal mucosa that extend beyond muscularis mucosa Arise when mucosal defenses are impaired in presence of gastric acid and pepsin Overall incidence declining worldwide Lifetime prevalence 5-10% Complications GI bleeding (10-20%) Perforation (5%) Obstruction (2%)

5 Causes of peptic ulcers Helicobacter pylori infection Aspirin and NSAIDs Rare causes: Neoplasia (carcinoma, lymphoma, leiomyosarcoma) Acid hypersecretion (Zollinger-Ellison syndrome) Granulomatous disease (Crohn s, sarcoidosis) Systemic mastocytosis Infectious (CMV, HSV, TB) Familial Idiopathic (No H. pylori, NSAID or other identifiable cause)

6 Additional Risk Factors Older age Prior history of peptic ulcers Smoking proportional to amount smoked Medications in combination with NSAIDs Corticosteroids, anticoagulants, antiplatelets, SSRIs, bisphosphonates

7 Helicobacter pylori Gram-neg spiral, urease producing bacteria H. pylori is the most common chronic bacterial infection in humans Infection mainly acquired in childhood (<10 years) Risk factors include Low socioeconomic status Household crowding Country of origin and ethnicity Cover TL, Blaser MJ. Gastroenterology 2009;136(6): ; Bruce MG Epidemiol Infect 2015;143(6):1236-4

8 H. pylori and peptic ulcers H. pylori associated with up to 80% duodenal ulcers H. pylori associated with up to 70% gastric ulcers Prevalence of H. pylori Undeveloped countries 80% by age 20 Developed countries 10% by age 20 Incidence of peptic ulcers declining in developed countries due to less H. pylori 50% to 60% to

9 H. pylori eradication results in long-term remission of peptic ulcer disease Duodenal ulcer % Patients in remission 100 H. pylori eradicated 75 Gastric ulcer % Patients in remission 100 H. pylori eradicated H. pylori-positive 25 H. pylori-positive Years after termination of treatment Months after termination of treatment Miehlke S. Eur J Gastroenterol Hepatol 1995;7(10):975-8; Axon AT. BMJ 1997;314(7080):565-8

10 NSAIDs and peptic ulcers Responsible for majority of ulcers not due to H. pylori (>100,000 hospitalizations/year) Increased risk for significant GI event (bleeding, perforation and obstruction) and silent ulcers Surreptitious NSAID use is common, especially in refractory / complicated ulcers Co-therapy of NSAIDs with corticosteroids, anticoagulants, other NSAIDs, low dose aspirin, selective serotonin reuptake inhibitors (SSRIs) and alendronate increases the risk of ulcers

11 Risk of ulcer complications with ASA and NSAIDs ASA + ASA + > > ASA + NSAIDs COX-2 inhibitor placebo ASA alone causes a 2-3 fold increase in ulcer bleeding Long term ASA use does not reduce risk of ASA-induced ulcer bleed (Meta-analysis of 24 RCTs) Enteric coated or buffered ASA does not protect against ulcers due to systemic effects Garcia Rodriguez LA. Gastroenterology 2007;132(2): ; Derry S, Loke YK. BMJ 2000;321(7270):1183-7

12 Risk factors for NSAIDinduced peptic ulcers Risk Factor Relative Risk 95 Percent CI Overall Anticoagulants High dosage (>2x normal) Age (>60) Prior PUD Corticosteroids

13 Other causes of peptic ulcers Gastric acid hypersecretion Zollinger-Ellison syndrome Cigarette smoking Increased rate of ulcers in patients with H. pylori More difficult to treat ulcers Neoplasia (carcinoma, lymphoma) Familial (polygenic inheritance)

14 Zollinger-Ellison Syndrome Neuroendocrine tumor (duodenum, pancreas) Hypergastrinemia acid secretion PUD (duodenum, jejunum), diarrhea, GERD Usually sporadic MEN1 syndrome in 25% of cases Diagnosis gastrin, cross-sectional imaging Ddx hypergastrinemia hypochlorhydria from PPI or atrophic gastritis

15 Clinical manifestations of peptic ulcer disease Dyspepsia: epigastric pain most common Duodenal ulcer symptoms Epigastric pain (burning, gnawing or hunger-like), 2 to 5 hours after meal or on empty stomach (without a food buffer) Nocturnal between 11 PM and 2 AM (circadian stimulation of acid maximal) Symptom relief with food or antacids Gastric ulcer symptoms: Pain soon after meals with less relief by food or antacids Ulcers can be asymptomatic (up to 70%)

16 Differential diagnosis of peptic ulcer disease Functional nonulcer dyspepsia Gastroesophageal reflux disease Gastric cancer Pancreatic and biliary diseases

17 Alarm symptoms Weight loss Persistent vomiting Dysphagia Anemia Hematemesis Palpable abdominal mass Family H/O upper GI carcinoma Previous gastric surgery

18 Diagnosis of peptic ulcer disease Suspect by symptoms and history Ask about alarm symptoms Consider blood tests CBC, LFT s, calcium and lipase Test for H. pylori infection Consider endoscopy

19 Upper endoscopy for PUD Upper endoscopy gold standard test Best in patients over the age of 45 years or with alarm symptoms Allows biopsy (for H. pylori or to R/O cancer) Sensitive, specific and safe Best initial test in most patients

20 Gastric ulcer

21 Antisecretory therapy for PUD H 2 -blockers 90% effective after 8 weeks Proton pump inhibitors More rapid healing than H 2 -blockers 90% effective at 4 weeks Large ulcers (>2 cm) take longer to heal Gastric ulcers confirm healing and exclude malignancy in 8 to 12 weeks Continue maintenance PPIs in patients with non H. pylori, non NSAID ulcers

22 Diagnostic tests for H. pylori infection

23 Endoscopy-based methods of detecting H. pylori Method of Diagnosis Main Indication Sensitivity (%) Specificity (%) Histology Diagnosis Culture Rapid urease test (CLO) H. pylori antibiotic sensitivities Rapid results in endoscopy room

24 Gastric biopsies with H. pylori

25 Noninvasive methods of detecting H. pylori Method of Diagnosis Main Indication Sensitivity (%) Specificity (%) Serology Screening Urea breath test Stool antigen test Screening and confirm eradication Screening and confirm eradication

26 Principle of 13 C + 14 C-urea breath test

27 General principles of treating PUD Heal ulcer by decreasing gastric acid using PPIs or H 2 RAs Treat the underlying cause: Test and eradicate H. pylori infection For NSAID-related ulcers - Discontinue or switch to non-nsaid analgesic - For patients who require chronic NSAIDs, consider co-therapy with PPI (or misoprostol)

28 Established recommendations for H. pylori eradication Strong evidence to treat Gastric or duodenal ulcers (current or H/O untreated H. pylori) MALT lymphoma Also recommended (limited evidence of benefit) Atrophic gastritis / intestinal metaplasia Gastric adenocarcinoma in early stages 1st degree relatives of patients with gastric cancer Maastricht IV Consensus Report. Gut 2012;61(5):646-64; Liang X. Clin Gastroenterol Hepatol 2013;11(7):802-7

29 New recommendations for H. pylori eradication Any patient with a positive test not previously treated Non-ulcer dyspepsia Under the age of 60 years without alarm features who undergo nonendoscopic testing and found to have H. pylori Those who undergo endoscopy and are found to have H. pylori Prior to long-term NSAID or ASA use to reduce risk of bleeding (in patients with H. pylori) Patients with unexplained iron deficiency anemia despite an appropriate evaluation (in patients with H. pylori) Adults with idiopathic thrombocytopenic purpura (ITP) should be tested for and treated if H. pylori present Chey WD. Am J Gastroenterol 2017;112:

30 Treatment of H. pylori Multiple regimens and durations evaluated Treatment must be effective, have acceptable costs, side effects and ease of administration Commonly used regimens have frequent side effects (usually mild) including metallic taste, diarrhea and allergic reactions Be aware of clarithromycin and metronidazole resistance and do not repeat Rx with these drugs Best regimens eradicate organism > 90%

31 H. pylori eradication therapies Clarithromycin triple therapy PPI BID+ 2 antibiotics including clarithromycin Determine if patient had previous macrolide exposure Clarithromycin may be used if local resistance low (resistance <15%) Bismuth quadruple therapy PPI BID+ Bismuth salt + 2 antibiotics Other first line regimens Salvage therapy Avoid initial antibiotics and offer to those with persistent infection after initial therapy Liang X. Clin Gastroenterol Hepatol 2013;11(7):802-7; Chey WD. Am J Gastroenterol 2017;112:

32 Clarithromycin triple therapy Proton pump inhibitor twice daily Amoxicillin 1 gram twice daily Clarithromycin 500 mg twice daily All given for 14 days Can substitute Metronidazole 500 mg twice daily if penicillin allergic

33 Bismuth quadruple therapy Proton pump inhibitor twice daily Bismuth subcitrate or subsalicylate 2 tablets 4 times daily Tetracycline 500 mg 4 times daily Metronidazole mg 4 times daily All given with meals for days First line therapy if prior macrolide exposure or penicillin allergy

34 2017 H. pylori Treatment Guidelines American College of Gastroenterology (ACG) Chey WD. Am J Gastroenterol 2017;112:

35 Levofloxacin triple therapy Proton pump inhibitor twice daily Amoxicillin 1 gram twice daily Levofloxacin 500 mg once daily All given for days

36 Concomitant therapy Proton pump inhibitor twice daily Amoxicillin 1 gram twice daily Clarithromycin 500 mg twice daily Nitroimidazole (metronidazole or tinidazole) 500 mg twice daily All given for days

37 Confirmation of H. pylori eradication Recommended for all treated patients Serologic testing not useful Urea breath testing or stool antigen testing Repeat testing 4-6 weeks after therapy Patients need to avoid using antibiotics, bismuth compounds and PPIs (for 1-2 weeks) which can cause false negative results

38 Salvage regimens Use for recurrent or persistent H. pylori If clarithromycin used as first line therapy Bismuth quadruple therapy x 14 days Levofloxacin triple therapy x 14 days If Bismuth used as first line therapy Clarithromycin triple therapy x 14 days Levofloxacin triple therapy x 14 days Concomitant therapy alternative option

39 Treatment recommendations for NSAID-related peptic ulcers Heal ulcer with acid lowering medications Test and eradicate any H. pylori infection Discontinue or switch to non-nsaid analgesic For patients requiring chronic NSAIDs consider strategies to prevent recurrent ulcers

40 Preventing recurrent ulcers in patients requiring chronic NSAIDs Use lowest dose of NSAID and provide cotherapy with either PPI or misoprostol (prostaglandin E1 analogue) Switch to a selective COX-2 inhibitor Effective anti-inflammatory agents Less ulcer complications than nonselective NSAIDs Increases cardiovascular events (RR =1.42) Sung JJ. Gut 2011;60(9):1170-7; Laine L. Aliment Pharmacol Ther 2009;30(7):767-74

41 Complications of peptic ulcers Gastrointestinal bleeding 10-20% Gastric outlet obstruction 2% Perforation/fistulalization 5% Usually occur in chronic peptic ulcers May develop in days - weeks of NSAIDs May occur heralded by symptoms or may occur in silent ulcers

42 Bleeding peptic ulcers Accounts for over 50% severe UGI bleeding Overall mortality rate 2-14% Resuscitation is critical Restrictive transfusion strategy (Hgb < 7 g/dl) Acid suppression with PPIs Endoscopy within 24 hours Crooks C. Gastroenterology 2011;141(1):62-70; Villanueva C. N Engl J Med 2013;368(1):11-21

43 Restrictive vs. liberal transfusion strategy 921 patients with acute upper GI bleeding Restrictive: Transfuse when Hgb < 7 g/dl Liberal: Transfuse when Hgb < 9 g/dl Further GI bleed Adverse events 10% 16% (P=0.01) 40% 48% (P=0.02) Survival at 6 weeks 95% 91% Hazard ratio: 0.55 (95%CI:0.33 to 0.92 ; P=0.02) Villanueva C. N Engl J Med 2013;368(1):11-21

44 Overall Survival (%) Survival according to transfusion strategy Days

45 Event rate (%) RCT of aspirin vs. placebo after peptic ulcer bleed Sung JJ. Ann Intern Med 2010;152:1-9

46 Resumption of aspirin after upper GI bleeding American College of Gastroenterology Guidelines If given for secondary prevention (i.e. established CV disease) then aspirin should be resumed as soon as possible after bleeding ceases in most patients: ideally within 1-3 days and certainly within 7 days Laine L, Jensen DM. Am J Gastroenterol 2012;107:345-60

47 Summary NSAIDs/ASA and H. pylori are the major causes of peptic ulcers Test for and eradicate H. pylori using established treatments regimens For ulcer patients requiring chronic NSAIDs Treat with PPI (misoprostol) or COX2 NSAID For bleeding ulcer patients requiring ASA Restart ASA within 7 days with a PPI

48 Questions

49 Question 1 A 47 year old man presents with a bleeding gastric ulcer with biopsies showing H. pylori infection. He is treated with clarithromycin triple therapy including a PPI, amoxicillin and clarithromycin. At 8 weeks repeat upper endoscopy shows that the ulcer has healed but H. pylori is still present. His next course of H. pylori treatment should avoid use of the following medication: a) Proton pump inhibitors b) Amoxicillin c) Clarithromycin d) Metronidazole e) Bismuth subsalicylate

50 Question 1 A 47 year old man presents with a bleeding gastric ulcer with biopsies showing H. pylori infection. He is treated with clarithromycin triple therapy including a PPI, amoxicillin and clarithromycin. At 8 weeks repeat upper endoscopy shows that the ulcer has healed but H. pylori is still present. His next course of H. pylori treatment should avoid use of the following medication: a) Proton pump inhibitors b) Amoxicillin c) Clarithromycin d) Metronidazole e) Bismuth subsalicylate

51 The answer is C Commonly used regimes to treat H. pylori include clarithromycin triple therapy (PPI BID + 2 antibiotics including clarithromycin) and Bismuth quadruple therapy (PPI BID, Bismuth + 2 antibiotics) Clinicians need to be aware of clarithromycin and metronidazole resistance If a patient is previously treated with clarithromycin or metronidazole, a repeat treatment for H. pylori should not use these drugs Maastricht IV Consensus Report. Gut 2012;61(5):646-64; Chey WD. Am J Gastroenterol 2017;112:

52 Question 2 A 62 year old male presents with abdominal pain, nausea, and passage of dark black stools. He has diabetes, hypertension, and coronary artery disease and takes aspirin daily for secondary prophylaxis. An upper endoscopy shows a duodenal ulcer with a visible vessel that is treated with endoscopic hemostasis. Biopsies of the stomach show no H. pylori present. He remains stable for 3 days and starts treatment with oral PPI therapy. What are your recommendations about further antiplatelet therapy? a) Discontinue aspirin therapy b) Switch aspirin therapy to clopidogrel c) Continue an oral PPI and restart aspirin at this time d) Continue an oral PPI and restart aspirin therapy after 4 weeks

53 Question 2 A 62 year old male presents with abdominal pain, nausea, and passage of dark black stools. He has diabetes, hypertension, and coronary artery disease and takes aspirin daily for secondary prophylaxis. An upper endoscopy shows a duodenal ulcer with a visible vessel that is treated with endoscopic hemostasis. Biopsies of the stomach show no H. pylori present. He remains stable for 3 days and starts treatment with oral PPI therapy. What are your recommendations about further antiplatelet therapy? a) Discontinue aspirin therapy b) Switch aspirin therapy to clopidogrel c) Continue an oral PPI and restart aspirin at this time d) Continue an oral PPI and restart aspirin therapy after 4 weeks

54 The answer is C The patient has significant cardiovascular disease requiring continued anti-platelet therapy The use of a PPI given with aspirin is superior to switching to clopidogrel alone in reducing recurrent ulcer bleeding He should continue oral PPI therapy and restart aspirin as soon as possible This strategy significantly reduces mortality as compared to restarting aspirin several weeks later Sung JJ. Ann Intern Med 2010;152:1-9

55 No disclosures Disclosures

56 References Chey ED. ACG Clinical Guideline: Treatment of Helicobacter pylori Infection. Am J Gastroenterol 2017;112: Graham DY. History of Helicobacter pylori, duodenal ulcer, gastric ulcer and gastric cancer. World J Gastroenterol 2014;20: Kumar NL. Initial management and timing of endoscopy in nonvariceal upper GI bleeding. Gastrointest Endosc 2016;84(1):10-7 Lau JY. Challenges in the management of acute peptic ulcer bleeding. Lancet 2013;381: Malfertheiner P. Management of Helicobacter pylori infection-the Maastricht IV/ Florence Consensus Report. Gut 2012;61(5): Laine L Jensen DM. Am J Gastroenterol 2012;107: Villanueva C. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med 2013;368(1):11-21

Helicobacter 2008;13:1-6. Am J Gastroent 2007;102: Am J of Med 2004;117:31-35.

Helicobacter 2008;13:1-6. Am J Gastroent 2007;102: Am J of Med 2004;117:31-35. An Update on Helicobacter pylori and Its Treatment Trenika Mitchell, PharmD, BCPS Clinical Assistant Professor University of Kentucky College of Pharmacy October 18, 2008 Objectives Review the epidemiology

More information

Treatment of Helicobacter pylori Infection

Treatment of Helicobacter pylori Infection Treatment of Helicobacter pylori Infection Epidemiology of H. pylori infection (North America) Which are the high risk groups? Epidemiology of H. pylori infection (North America) Which are the high risk

More information

CHAPTER 18. PEPTIC ULCER DISEASE, SELF-ASSESSMENT QUESTIONS. 1. Which of the following is not a common cause of peptic ulcer disease (PUD)?

CHAPTER 18. PEPTIC ULCER DISEASE, SELF-ASSESSMENT QUESTIONS. 1. Which of the following is not a common cause of peptic ulcer disease (PUD)? CHAPTER 18. PEPTIC ULCER DISEASE, SELF-ASSESSMENT QUESTIONS 1. Which of the following is not a common cause of peptic ulcer disease (PUD)? A. Chronic alcohol ingestion B. Nonsteroidal antiinflammatory

More information

ACG Clinical Guideline: Treatment of Helicobacter pylori Infection

ACG Clinical Guideline: Treatment of Helicobacter pylori Infection ACG Clinical Guideline: Treatment of Helicobacter pylori Infection William D. Chey, MD, FACG 1, Grigorios I. Leontiadis, MD, PhD 2, Colin W. Howden, MD, FACG 3 and Steven F. Moss, MD, FACG 4 1 Division

More information

Proton Pump Inhibitors Drug Class Prior Authorization Protocol

Proton Pump Inhibitors Drug Class Prior Authorization Protocol Proton Pump Inhibitors Drug Class Prior Authorization Protocol Line of Business: Medi-Cal P&T Approval Date: November 15, 2017 Effective Date: January 1, 2018 This policy has been developed through review

More information

GASTROINTESTINAL AND ANTIEMETIC DRUGS. Submitted by: Shaema M. Ali

GASTROINTESTINAL AND ANTIEMETIC DRUGS. Submitted by: Shaema M. Ali GASTROINTESTINAL AND ANTIEMETIC DRUGS Submitted by: Shaema M. Ali GASTROINTESTINAL AND ANTIEMETIC DRUGS by: Shaema M. Ali There are four common medical conditions involving the GI system 1) peptic ulcers

More information

Peptic Ulcer Disease Update

Peptic Ulcer Disease Update Peptic Ulcer Disease Update Col Pat Storms RAM 2005 Disclosure Information 84th Annual AsMA Scientific Meeting Col Patrick Storms I have no financial relationships to disclose. I will discuss the following

More information

Peptic ulcer disease Disorders of the esophagus

Peptic ulcer disease Disorders of the esophagus Peptic ulcer disease Disorders of the esophagus Peptic ulcer disease Burning epigastric pain Exacerbated by fasting Improved with meals Ulcer: disruption of mucosal integrity >5 mm in size, with depth

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: helicobacter_pylori_testing 01/01/2019 N/A 01/01/2020 01/01/2019 Policy Effective April 1, 2019 Description

More information

MANAGEMENT OF DYSPEPSIA AND GASTRO-OESOPHAGEAL REFLUX DISEASE (GORD)

MANAGEMENT OF DYSPEPSIA AND GASTRO-OESOPHAGEAL REFLUX DISEASE (GORD) DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) MANAGEMENT OF DYSPEPSIA AND GASTRO-OESOPHAGEAL REFLUX DISEASE (GORD) Routine endoscopic investigation of patients of any age, presenting with dyspepsia

More information

Acid-Peptic Diseases of the Stomach and Duodenum Including Helicobacter pylori and NSAIDs Prof. Sheila Crowe

Acid-Peptic Diseases of the Stomach and Duodenum Including Helicobacter pylori and NSAIDs Prof. Sheila Crowe Acid-Peptic Diseases of the Stomach and Duodenum Including Helicobacter pylori and NSAIDs 1 Division of Gastroenterology UC San Diego School of Medicine Clinical presentations of Helicobacter pylori infection

More information

Helicobacter Pylori Testing HELICOBACTER PYLORI TESTING HS-131. Policy Number: HS-131. Original Effective Date: 9/17/2009

Helicobacter Pylori Testing HELICOBACTER PYLORI TESTING HS-131. Policy Number: HS-131. Original Effective Date: 9/17/2009 Easy Choice Health Plan, Inc. Harmony Health Plan of Illinois, Inc. Missouri Care, Inc. Ohana Health Plan, a plan offered by WellCare Health Insurance of Arizona, Inc. WellCare Health Insurance of Illinois,

More information

KK College of Nursing Peptic Ulcer Badil D ass Dass, Lecturer 25th July, 2011

KK College of Nursing Peptic Ulcer Badil D ass Dass, Lecturer 25th July, 2011 KK College of Nursing Peptic Ulcer Badil Dass, Lecturer 25 th July, 2011 Objectives: By the end of this lecture, the students t will be able to: Define peptic pp ulcer Describe the etiology and pathology

More information

Management of dyspepsia and of Helicobacter pylori infection

Management of dyspepsia and of Helicobacter pylori infection Management of dyspepsia and of Helicobacter pylori infection The University of Nottingham John Atherton Wolfson Digestive Diseases Centre University of Nottingham, UK Community management of dyspepsia

More information

Treating H. pylori in 2016

Treating H. pylori in 2016 Treating H. pylori in 2016 William D. Chey, MD, FACG Professor of Medicine University of Michigan The Case: A 38 yo Russian man presents with recurrent epigastric pain which occurs after meals and sometimes

More information

Epidemiology of Peptic Ulcer Disease

Epidemiology of Peptic Ulcer Disease Epidemiology of Peptic Ulcer Disease Introduction Peptic Ulcer Disease (PUD) is disruption of the mucosal integrity of the stomach and/or duodenum leading to a local defect or excavation due to active

More information

What is the status of Sequential Therapy Versus Standard Triple- Drug Therapy in peptic ulcer disease in eradicating H pylori?

What is the status of Sequential Therapy Versus Standard Triple- Drug Therapy in peptic ulcer disease in eradicating H pylori? What is the status of Sequential Therapy Versus Standard Triple- Drug Therapy in peptic ulcer disease in eradicating H pylori? Sequential Therapy Versus Standard Triple- Drug Therapy for Helicobacter pylori

More information

DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) MANAGEMENT OF DYSPEPSIA

DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) MANAGEMENT OF DYSPEPSIA DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) MANAGEMENT OF DYSPEPSIA o Patients of any age with ALARM signs should be referred through the 2-week referral system o Routine endoscopic investigation

More information

Helicobacter pylori: Diagnosis, treatment and risks of untreated infection

Helicobacter pylori: Diagnosis, treatment and risks of untreated infection Helicobacter pylori: Diagnosis, treatment and risks of untreated infection Klaus Mönkemüller Department of Gastroenterology, Hepatology und Infectius Diseases Otto-von-Guericke University, Magdeburg bb

More information

EDUCATION PRACTICE. Persistent Helicobacter pylori Infection After a Course of Antimicrobial Therapy What s Next? Clinical Scenario.

EDUCATION PRACTICE. Persistent Helicobacter pylori Infection After a Course of Antimicrobial Therapy What s Next? Clinical Scenario. CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2008;6:1086 1090 EDUCATION PRACTICE Persistent Helicobacter pylori Infection After a Course of Antimicrobial Therapy What s Next? RICHARD J. SAAD* and WILLIAM D.

More information

Management of Dyspepsia

Management of Dyspepsia MPharm Programme Management of Dyspepsia Slide 1 of 28 Learning Objectives Understand the principles and wider implications underpinning evidence based therapeutics in the key clinical specialities Objectively

More information

Bleeds in Cardiovascular Disease

Bleeds in Cardiovascular Disease Preventing Gastrointestinal Bleeds in Cardiovascular Disease Patients t on Aspirin i Joel C. Marrs, Pharm.D., BCPS Clinical Assistant Professor OSU/OHSU College of Pharmacy Pharmacy Practice IX (PHAR 766)

More information

GASTROINTESTINAL SYSTEM MANAGEMENT OF DYSPEPSIA

GASTROINTESTINAL SYSTEM MANAGEMENT OF DYSPEPSIA GASTROINTESTINAL SYSTEM MANAGEMENT OF DYSPEPSIA MANAGEMENT Dyspepsia refers to a spectrum of usually intermittent upper gastrointestinal symptoms, including epigastric pain and heartburn. For the majority

More information

Abdominal Pain in a Young Aviator

Abdominal Pain in a Young Aviator Abdominal Pain in a Young Aviator Calen N. Wherry, MD, MPH Maj, USAF, MC, FS Peter A. Baldwin, MD, MBA, MPH Capt, USAF, MC, FS USAF School of Aerospace Medicine WPAFB, OH RAM 2013 Distribution A: Approved

More information

Updates in Evaluation and Management of Dyspepsia and H. Pylori Infection

Updates in Evaluation and Management of Dyspepsia and H. Pylori Infection Updates in Evaluation and Management of Dyspepsia and H. Pylori Infection Isabel Lee, MD Associate Professor of Health Sciences UCSF Department of Family and Community Medicine Disclosures None 2 Session

More information

Gastro-oesophageal reflux disease and peptic ulcer disease. By: Dr. Singanamala Suman Assistant Professor Department of Pharm.D

Gastro-oesophageal reflux disease and peptic ulcer disease. By: Dr. Singanamala Suman Assistant Professor Department of Pharm.D Gastro-oesophageal reflux disease and peptic ulcer disease By: Dr. Singanamala Suman Assistant Professor Department of Pharm.D Gastro-oesophageal reflux disease and peptic ulcer disease Learning objectives:

More information

Peptic Ulcer Disease & Gastritis Michel-Jose Charles, MD

Peptic Ulcer Disease & Gastritis Michel-Jose Charles, MD Peptic Ulcer Disease & Gastritis Michel-Jose Charles, MD Internal Medicine Gastroenterology Board Certified Assistant Professor 2016 Peptic Ulcer Disease and Gastritis Michel-Jose Charles, MD Gastroenterology

More information

Helicobacter pylori 幽門螺旋桿菌 馬偕紀念醫院新竹分院一般內科, 肝膽腸胃科陳重助醫師

Helicobacter pylori 幽門螺旋桿菌 馬偕紀念醫院新竹分院一般內科, 肝膽腸胃科陳重助醫師 Helicobacter pylori 幽門螺旋桿菌 馬偕紀念醫院新竹分院一般內科, 肝膽腸胃科陳重助醫師 Hp : Helicobacter pylori Part 1. Pathophysiology and immune response Pathogenesis of Hp infection Part 2. Clinical manifestation Part 3. Dx tests for

More information

On-Call Upper GI Bleeding. Upper Gastrointestinal Bleeding

On-Call Upper GI Bleeding. Upper Gastrointestinal Bleeding On-Call Upper GI Bleeding John R Saltzman MD, FACG Director of Endoscopy Brigham and Women s Hospital Associate Professor of Medicine Harvard Medical School Upper Gastrointestinal Bleeding 300,000000 hospitalizations/year

More information

American College of Gastroenterology Guideline on the Management of Helicobacter pylori Infection

American College of Gastroenterology Guideline on the Management of Helicobacter pylori Infection American Journal of Gastroenterology ISSN 0002-9270 C 2007 by Am. Coll. of Gastroenterology doi: 10.1111/j.1572-0241.2007.01393.x Published by Blackwell Publishing American College of Gastroenterology

More information

The usual dose is 40 mg daily with amoxycillin 1.5 g (750 mg b.d.) for 2 weeks. Up to 2 g/day of amoxycillin has been used in clinical trials.

The usual dose is 40 mg daily with amoxycillin 1.5 g (750 mg b.d.) for 2 weeks. Up to 2 g/day of amoxycillin has been used in clinical trials. Name Gasec - 2 Gastrocaps Composition Gasec-20 Gastrocaps Each Gastrocaps contains: Omeprazole 20 mg (in the form of enteric-coated pellets) Properties, effects Proton Pump Inhibitor Omeprazole belongs

More information

Disclosures. Co-founder and Chief Science Officer, TechLab

Disclosures. Co-founder and Chief Science Officer, TechLab H. pylori testing Disclosures Co-founder and Chief Science Officer, TechLab Learning Objectives Evaluate the appropriate testing methodology by balancing performance, economics, and workflow. Discuss the

More information

Guidelines for the Management of Dyspepsia and GORD. Gastroenterology/ Acute Adult Governance. Drugs and Therapeutics Committee

Guidelines for the Management of Dyspepsia and GORD. Gastroenterology/ Acute Adult Governance. Drugs and Therapeutics Committee Guidelines for the Management of Dyspepsia and GORD Document type: Version: 3.0 Author (name): Author (designation): Validated by Prescribing Dr. G. Lipscomb Date validated October 2015 Ratified by: Date

More information

Prevpac Pylera Omeclamox-Pak

Prevpac Pylera Omeclamox-Pak Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.50.21 Subject: -Pak Page: 1 of 5 Last Review Date: September 20, 2018 -Pak Description (lansoprazole,

More information

SELECTED ABSTRACTS. Figure. Risk Stratification Matrix A CLINICIAN S GUIDE TO THE SELECTION OF NSAID THERAPY

SELECTED ABSTRACTS. Figure. Risk Stratification Matrix A CLINICIAN S GUIDE TO THE SELECTION OF NSAID THERAPY SELECTED ABSTRACTS A CLINICIAN S GUIDE TO THE SELECTION OF NSAID THERAPY The authors of this article present a 4-quadrant matrix based on 2 key clinical parameters: risk for adverse gastrointestinal (GI)

More information

Management of dyspepsia in adults in primary care

Management of dyspepsia in adults in primary care Dyspepsia Management of dyspepsia in adults in primary care June 2005. The recommendations on referral for endoscopy in this NICE guideline have been amended in line with the recommendation in the NICE

More information

Peptic ulcer disease. Nomin-Erdene. D SOM-531

Peptic ulcer disease. Nomin-Erdene. D SOM-531 Peptic ulcer disease Nomin-Erdene. D SOM-531 Learning objectives Stomach gross anatomy PUD Epidemiology Pathogenesis Clinical manifestation Diagnosing Treatment Complicated ulcer disease Surgical procedures

More information

Urea Breath Test for Diagnosis of Helicobactor pylori. Original Policy Date 12:2013

Urea Breath Test for Diagnosis of Helicobactor pylori. Original Policy Date 12:2013 MP 2.04.04 Urea Breath Test for Diagnosis of Helicobactor pylori Medical Policy Section Medicine Issue 12:2013 Original Policy Date 12:2013 Last Review Status/Date 12:2013 Return to Medical Policy Index

More information

National Digestive Diseases Information Clearinghouse

National Digestive Diseases Information Clearinghouse Gastritis National Digestive Diseases Information Clearinghouse U.S. Department of Health and Human Services NATIONAL INSTITUTES OF HEALTH What is gastritis? Gastritis is a condition in which the stomach

More information

COMPARISON OF ONCE-A-DAY VERSUS TWICE-A-DAY CLARITHROMYCIN IN TRIPLE THERAPY FOR HELICOBACTER PYLORI ERADICATION

COMPARISON OF ONCE-A-DAY VERSUS TWICE-A-DAY CLARITHROMYCIN IN TRIPLE THERAPY FOR HELICOBACTER PYLORI ERADICATION Phil J Gastroenterol 2006; 2: 25-29 COMPARISON OF ONCE-A-DAY VERSUS TWICE-A-DAY CLARITHROMYCIN IN TRIPLE THERAPY FOR HELICOBACTER PYLORI ERADICATION Marianne P Collado, Ma Fatima P Calida, Peter P Sy,

More information

Helicobacter pylori. Objectives. Upper Gastrointestinal Bleeding Peptic Ulcer Disease

Helicobacter pylori. Objectives. Upper Gastrointestinal Bleeding Peptic Ulcer Disease Upper Gastrointestinal Bleeding Peptic Ulcer Disease Pharmacotherapy Issues in Acute Management and Secondary Prevention Peter J. Zed, B.Sc., B.Sc.(Pharm), Pharm.D. Pharmacotherapeutic Specialist - Emergency

More information

The PPI Doesn t Work, Now What? PPI Non-responsive Dyspepsia. Disclosures

The PPI Doesn t Work, Now What? PPI Non-responsive Dyspepsia. Disclosures The PPI Doesn t Work, Now What? PPI Non-responsive Dyspepsia Lana Bistritz MD FRCPC Royal Alexandra Hospital GI Update 2016 Disclosures I have no relevant financial disclosures I will be discussing off

More information

What Is Peptic Ulcer Disease?

What Is Peptic Ulcer Disease? What Is Peptic Ulcer Disease? Peptic ulcer disease is when painful sores form in the lining of the stomach, duodenum (start of the small intestine) or bowels. An ulcer can cause belly pain and, in some

More information

GI update. Common conditions and concerns my patients frequently asked about

GI update. Common conditions and concerns my patients frequently asked about GI update Common conditions and concerns my patients frequently asked about Specific conditions I ll try to cover today 1. Colon polyps, colorectal cancer and colonoscopy 2. Crohn s disease 3. Peptic ulcer

More information

Drug Class Monograph

Drug Class Monograph Drug Class Monograph Class: Proton Pump Inhibitors Drugs: Aciphex Sprinkle (rabeprazole), Dexilant (dexlansoprazole), Lansoprazole, Nexium (esomeprazole capsule, esomeprazole granules), Omeprazole, Pantoprazole,

More information

Surgery for Complications of Peptic Ulcer Disease (Definitive Treatment)

Surgery for Complications of Peptic Ulcer Disease (Definitive Treatment) Surgery for Complications of Peptic Ulcer Disease (Definitive Treatment) Amid Keshavarzi, MD UCHSC Grand Round 3/20/2006 Department of Surgery Introduction Epidemiology Pathophysiology Clinical manifestation

More information

EMILOK Global. (omeprazole) Composition: Each capsule contains 20 mg omeprazole as enteric-coated

EMILOK Global. (omeprazole) Composition: Each capsule contains 20 mg omeprazole as enteric-coated EMILOK Global (omeprazole) Composition: Each capsule contains 20 mg omeprazole as enteric-coated granules. Properties: Emilok (omeprazole) belongs to the group of proton pump inhibitors, inhibits both

More information

Helicobacter and gastritis

Helicobacter and gastritis 1 Helicobacter and gastritis Dr. Hala Al Daghistani Helicobacter pylori is a spiral-shaped gram-negative rod. H. pylori is associated with antral gastritis, duodenal (peptic) ulcer disease, gastric ulcers,

More information

HELICOBACTER PYLORI UPDATE

HELICOBACTER PYLORI UPDATE HELICOBACTER PYLORI UPDATE PROF. TAWHEED MOWAFY DEAN OF AZAL FACULTY OF MEDICINE INTRODUCTION (H. pylori) is recognised as the most common chronic human bacterial infection,1 affecting up to 50% of the

More information

Case 4: Peptic Ulcer Disease. Requejo, April Salandanan, Geralyn Talingting, Vennessa Tanay, Arvie

Case 4: Peptic Ulcer Disease. Requejo, April Salandanan, Geralyn Talingting, Vennessa Tanay, Arvie Case 4: Peptic Ulcer Disease Requejo, April Salandanan, Geralyn Talingting, Vennessa Tanay, Arvie Case 4: PUD Problem List: 1. Peptic Ulcer Disease SOAP Note: S Patient is complaining of abdominal pain

More information

6/25/ % 20% 50% 19% Functional Dyspepsia Peptic Ulcer GERD Cancer Other

6/25/ % 20% 50% 19% Functional Dyspepsia Peptic Ulcer GERD Cancer Other Peptic Ulcer Disease and Dyspepsia John M. Inadomi, MD Professor of Medicine UCSF Chief, Clinical Gastroenterology San Francisco General Hospital Case History 49 y/o woman complains of several months of

More information

Peptic ulcer disease: an update on diagnosis and treatment

Peptic ulcer disease: an update on diagnosis and treatment MODERN MEDICINE CPD ARTICLE NUMBER TWO: 1 point Peptic ulcer disease: an update on diagnosis and treatment BRUCE H McGARITY, FRACP; MARITA L MORGIA, MB BS The two miyor causes of peptic ulcer disease are

More information

Low Dose Furazolidone for Eradication of H- pylori Instead of Clarithromycin: A Clinical Trial

Low Dose Furazolidone for Eradication of H- pylori Instead of Clarithromycin: A Clinical Trial Global Journal of Health Science; Vol. 7, No. 1; 2015 ISSN 1916-9736 E-ISSN 1916-9744 Published by Canadian Center of Science and Education Low Dose Furazolidone for Eradication of H- pylori Instead of

More information

GI Pharmacology. Dr. Alia Shatanawi 5/4/2018

GI Pharmacology. Dr. Alia Shatanawi 5/4/2018 GI Pharmacology Dr. Alia Shatanawi 5/4/2018 Z Gastroenterol. 1983 Mar;21 Suppl:111-6. [Effect of antacids on intestinal motility]. [Article in German] Wienbeck M, Erckenbrecht J, Strohmeyer G. Abstract

More information

Index. Note: Page numbers of article titles are in boldface type.

Index. Note: Page numbers of article titles are in boldface type. Note: Page numbers of article titles are in boldface type. A Adherence, to bismuth quadruple therapy, 543 546 Adjuvant therapy, probiotics as, 567 569 Age factors, in gastric cancer, 611 612, 616 AID protein,

More information

MEDICAL POLICY EFFECTIVE DATE: 05/19/11 REVISED DATE: 05/24/12, 05/23/13 ARCHIVED DATE: 05/22/14 EDITED DATE: 05/28/15, 05/25/16, 05/18/17, 05/17/18

MEDICAL POLICY EFFECTIVE DATE: 05/19/11 REVISED DATE: 05/24/12, 05/23/13 ARCHIVED DATE: 05/22/14 EDITED DATE: 05/28/15, 05/25/16, 05/18/17, 05/17/18 MEDICAL POLICY SUBJECT: NON-INVASIVE HELICOBACTER PAGE: 1 OF: 6 If a product excludes coverage for a service, it is not covered, and medical policy criteria do not apply. If a commercial product, including

More information

QUICK QUERIES. Topical Questions, Sound Answers

QUICK QUERIES. Topical Questions, Sound Answers QUICK QUERIES Topical Questions, Sound Answers Dyspepsia: An Evidence-Based Approach Alan B. R. Thomson, MD, PhD, FRCPC, FACP, FACG Presented at the University of Alberta s Medical Grand Rounds, University

More information

Second Asia Pacific Consensus Guidelines for Helicobacter pylori infection

Second Asia Pacific Consensus Guidelines for Helicobacter pylori infection doi:10.1111/j.1440-1746.2009.05982.x SPECIAL ARTICLE jgh_5982 1587..1600 Second Asia Pacific Consensus Guidelines for Helicobacter pylori infection K Ming Fock,* Peter Katelaris, Kentaro Sugano, Tiing

More information

ACG Clinical Guideline: Management of Patients with Ulcer Bleeding

ACG Clinical Guideline: Management of Patients with Ulcer Bleeding ACG Clinical Guideline: Management of Patients with Ulcer Bleeding Loren Laine, MD 1,2 and Dennis M. Jensen, MD 3 5 1 Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut,

More information

Treatment and Screening of H. pylori Infection in Alaskan Populations

Treatment and Screening of H. pylori Infection in Alaskan Populations Treatment and Screening of H. pylori Infection in Alaskan Populations Matthew F. Deraedt, Pharm.D. Lieutenant United States Public Health Service Alaska Native Medical Center Pharmacy Practice PGY-1 Resident

More information

Clinical Policy Title: Noninvasive testing for H. pylori

Clinical Policy Title: Noninvasive testing for H. pylori Clinical Policy Title: Noninvasive testing for H. pylori Clinical Policy Number: 08.01.04 Effective Date: January 1, 2016 Initial Review Date: August 19, 2015 Most Recent Review Date: August 17, 2016 Next

More information

Clinical Policy: Helicobacter Pylori Serology Testing Reference Number: CP.MP.153

Clinical Policy: Helicobacter Pylori Serology Testing Reference Number: CP.MP.153 Clinical Policy: Reference Number: CP.MP.153 Effective Date: 12/17 Last Review Date: 12/17 Coding Implications Revision Log See Important Reminder at the end of this policy for important regulatory and

More information

Disease of the Stomach

Disease of the Stomach Disease of the Stomach Jack Bragg, D.O., F.A.C.O.I. Associate Professor of Internal Medicine Division of Gastroenterology University of Missouri School of Medicine Columbia, Missouri I have no disclosures

More information

Clinical Policy Title: Noninvasive testing for H. pylori

Clinical Policy Title: Noninvasive testing for H. pylori Clinical Policy Title: Noninvasive testing for H. pylori Clinical Policy Number: 08.01.04 Effective Date: January 1, 2016 Initial Review Date: August 19, 2015 Most Recent Review Date: August 17, 2016 Next

More information

High use of maintenance therapy after triple therapy regimes in Ireland

High use of maintenance therapy after triple therapy regimes in Ireland High use of maintenance therapy after triple therapy regimes in Ireland K Bennett, H O Connor, M Barry, C O Morain, J Feely Department of Pharmacology & Therapeutics Department of Gastroenterology Trinity

More information

Gastrointestinal pathology 2018 lecture 4. Dr Heyam Awad FRCPath

Gastrointestinal pathology 2018 lecture 4. Dr Heyam Awad FRCPath Gastrointestinal pathology 2018 lecture 4 Dr Heyam Awad FRCPath Topics to be covered Peptic ulcer disease Hiatal hernia Gastric neoplasms Peptic ulcer disease (PUD)= chronic gastric ulcer Causes H pylori

More information

June By: Reza Gholami

June By: Reza Gholami ACG/CAG guideline on Management of Dyspepsia June 2017 By: Reza Gholami DEFINITION OF DYSPEPSIA AND SCOPE OF THE GUIDELINE Dyspepsia was originally defined as any symptoms referable to the upper gastrointestinal

More information

Clinical Policy Title: Breath Testing for H. Pylori

Clinical Policy Title: Breath Testing for H. Pylori Clinical Policy Title: Breath Testing for H. Pylori Clinical Policy Number: 08.01.04 Effective Date: January 1, 2016 Initial Review Date: August 19, 2015 Most Recent Review Date: August 19, 2015 Next Review

More information

Sequioa Education Systems, Inc. 1

Sequioa Education Systems, Inc.  1 Functional Diagnostic Medicine Training Program Module 2 The Functional Diagnostic Medicine Approach in the Treatment of Gastrointestinal Dysfunction and Disease Dr. Wayne L. Sodano, D.C., D.A.B.C.I. &

More information

Perspectives from Viet Nam

Perspectives from Viet Nam International Symposium I (Management of antibiotics-resistant Helicobacter pylori infection) Perspectives from Viet Nam Vu Van Khien 1,HoDangQuyDung 2, Tran Thanh Binh 2 1 Department of GI Endoscopy,

More information

I. Kalfus MD, D. Riff MD, R. Fathi PhD, D. Graham MD

I. Kalfus MD, D. Riff MD, R. Fathi PhD, D. Graham MD A Randomized Double Blind Placebo Controlled Phase III Study to Assess the Safety and Efficacy of Rifabutin Triple Therapy (RHB-105) for Helicobacter pylori (H. pylori) Infection in Dyspepsia Patients

More information

Clinical Policy Title: Noninvasive testing for H. pylori

Clinical Policy Title: Noninvasive testing for H. pylori Clinical Policy Title: Noninvasive testing for H. pylori Clinical Policy Number: 08.01.05 Effective Date: January 1, 2016 Initial Review Date: August 19, 2015 Most Recent Review Date: August 17, 2017 Next

More information

University Medical Center at Brackenridge. Gastroenterology Clinic Worksheet

University Medical Center at Brackenridge. Gastroenterology Clinic Worksheet Gastroenterology Clinic Worksheet 1. GI Bleeding (occult or symptomatic) a. CBC b. Iron, Ferritin b. Medication history 2. Iron Deficiency Anemia and no evident source (if no iron deficiency consider hematological

More information

Stomach Pain Evidence-Based Methods in the Diagnosis and Treatment of Dyspepsia

Stomach Pain Evidence-Based Methods in the Diagnosis and Treatment of Dyspepsia 1 (11) Stomach Pain Evidence-Based Methods in the Diagnosis and Treatment of Dyspepsia Summary and Conclusions Introduction Following headache and fatigue, stomach problems represent one of the most common

More information

Fecal incontinence causes 196 epidemiology 8 treatment 196

Fecal incontinence causes 196 epidemiology 8 treatment 196 Subject Index Achalasia course 93 differential diagnosis 93 esophageal dysphagia 92 95 etiology 92, 93 treatment 93 95 work-up 93 Aminosalicylates, pharmacokinetics and aging effects 36 Antibiotics diarrhea

More information

GI Pharmacology. Dr. Alia Shatanawi 5/4/2018

GI Pharmacology. Dr. Alia Shatanawi 5/4/2018 GI Pharmacology Dr. Alia Shatanawi 5/4/2018 Drugs Used in Gastrointestinal Diseases Drugs used in Peptic Ulcer Diseases. Drugs Stimulating Gastrointestinal Motility &Laxatives. Antidiarrheal Agents. Drugs

More information

PLANNING COMMITTEE. Seek simplicity, and mistrust it. Alfred North Whitehead

PLANNING COMMITTEE. Seek simplicity, and mistrust it. Alfred North Whitehead PLANNING COMMITTEE 1. Content Experts Clinical experts Desmond Leddin MB FRCPC, Head, Division of Gastroenterology, Dalhousie University Drug evaluation pharmacist Pam McLean-Veysey BScPharm, Drug Evaluation

More information

1. Appropriateness of Gastroscopy: Dyspepsia 1

1. Appropriateness of Gastroscopy: Dyspepsia 1 Special Topic 579 1. Appropriateness of Gastroscopy: Dyspepsia 1 F. Froehlich *, M. Bochud **, J.-J. Gonvers*, R.W. Dubois***, J.-P. Vader **, V. Wietlisbach ***, B. Burnand ** * Policlinique Médicale

More information

Upper gastrointestinal bleeding in children. Nguyễn Diệu Vinh, MD Department of Gastroenterology

Upper gastrointestinal bleeding in children. Nguyễn Diệu Vinh, MD Department of Gastroenterology Upper gastrointestinal bleeding in children Nguyễn Diệu Vinh, MD Department of Gastroenterology INTRODUCTION Upper gastrointestinal (UGI) bleeding : arising proximal to the ligament of Treitz in the distal

More information

Chapter 63 Drugs Used in the Treatment of Gastrointestinal Diseases

Chapter 63 Drugs Used in the Treatment of Gastrointestinal Diseases Chapter 63 Drugs Used in the Treatment of Gastrointestinal Diseases p1009 DRUGS USED IN ACID-PEPTIC DISEASES 1. classification of drugs 2. agents that reduce intragastric acidity Antacids,H 2 antagonists,proton

More information

PREVENTING ASPIRIN-RELATED ULCER COMPLICATIONS

PREVENTING ASPIRIN-RELATED ULCER COMPLICATIONS PREVENTING ASPIRIN-RELATED ULCER COMPLICATIONS LANSOPRAZOLE FOR THE PREVENTION OF RECURRENCES OF ULCER COMPLICATIONS FROM LONG-TERM LOW-DOSE ASPIRIN USE KAM CHUEN LAI, M.R.C.P., SHIU KUM LAM, M.D., KENT

More information

Barrett s Esophagus. Abdul Sami Khan, M.D. Gastroenterologist Aurora Healthcare Burlington, Elkhorn, Lake Geneva, WI

Barrett s Esophagus. Abdul Sami Khan, M.D. Gastroenterologist Aurora Healthcare Burlington, Elkhorn, Lake Geneva, WI Barrett s Esophagus Abdul Sami Khan, M.D. Gastroenterologist Aurora Healthcare Burlington, Elkhorn, Lake Geneva, WI A 58 year-old, obese white man has had heartburn for more than 20 years. He read a magazine

More information

PRESCRIBING SUPPORT TEAM AUDIT: PROTON PUMP INHIBITOR PRESCRIBING REVIEW

PRESCRIBING SUPPORT TEAM AUDIT: PROTON PUMP INHIBITOR PRESCRIBING REVIEW PRESCRIBING SUPPORT TEAM AUDIT: PROTON PUMP INHIBITOR PRESCRIBING REVIEW DATE OF AUTHORISATION: AUTHORISING GP: PRESCRIBING SUPPORT TECHNICIAN: SUMMARY Dyspepsia refers to a broad range of symptoms related

More information

Peptic Ulcer Disease and NSAIDs

Peptic Ulcer Disease and NSAIDs Peptic Ulcer Disease and NSAIDs National Digestive Diseases Information Clearinghouse What is a peptic ulcer? A peptic ulcer is a sore on the inner lining of the stomach or duodenum the first part of the

More information

Proton Pump Inhibitors (PPIs) (Sherwood Employer Group)

Proton Pump Inhibitors (PPIs) (Sherwood Employer Group) Proton Pump Inhibitors (PPIs) (Sherwood Employer Group) BCBSKS will review Prior Authorization requests Prior Authorization Form: https://www.bcbsks.com/customerservice/forms/pdf/priorauth-6058ks-st-ippi.pdf

More information

High Recurrence Rate of Idiopathic Peptic Ulcers in Long-Term Follow-up

High Recurrence Rate of Idiopathic Peptic Ulcers in Long-Term Follow-up Gut and Liver, Vol. 7, No. 2, March 2013, pp. 175-181 ORiginal Article High Recurrence Rate of Idiopathic Peptic Ulcers in Long-Term Follow-up Hyuk Yoon, Sang Gyun Kim, Hyun Chae Jung, and In Sung Song

More information

Outline. GI-Bleeding. Initial intervention

Outline. GI-Bleeding. Initial intervention Internal Medicine Board Review 2016: GI-Bleeding Stephan Goebel, M.D. Assistant Professor Division of Digestive Diseases Management UGI-Bleeding (80%) Ulcers Varices others LGI-Bleeding (20%) Outline Initial

More information

PPIs: Good or Bad? 1. Basics of PPIs. Gastric Acid Basics. Outline. Gastric Acid Basics. Proton Pump Inhibitors (PPI)

PPIs: Good or Bad? 1. Basics of PPIs. Gastric Acid Basics. Outline. Gastric Acid Basics. Proton Pump Inhibitors (PPI) Outline Quick basics on Proton Pump Inhibitors (PPIs) PPIs: Good or Bad? What are potential risks of PPI therapy? How to approach your patients American Gastroenterology Association (AGA) recommendations

More information

Simon Everett. Consultant Gastroenterologist, SJUH, Leeds. if this is what greets you in the morning, you probably need to go see a doctor

Simon Everett. Consultant Gastroenterologist, SJUH, Leeds. if this is what greets you in the morning, you probably need to go see a doctor Simon Everett Consultant Gastroenterologist, SJUH, Leeds if this is what greets you in the morning, you probably need to go see a doctor Presentation Audit data and mortality NICE guidance Risk assessment

More information

OPEN ACCESS TEXTBOOK OF GENERAL SURGERY

OPEN ACCESS TEXTBOOK OF GENERAL SURGERY OPEN ACCESS TEXTBOOK OF GENERAL SURGERY PEPTIC ULCER DISEASE PC Bornman RS Du Toit EPIDEMIOLOGY AND PATHOGENESIS The prevalence of duodenal ulcer disease has a variable geographical distribution and differs

More information

Copy right protected Page 1

Copy right protected Page 1 DRUGS USED IN ULCERS AND GIT DISORDERS A peptic ulcer, also known as PUD or peptic ulcer disease is an ulcer of an area of the gastrointestinal tract that is usually acidic and thus extremely painful.

More information

Helicobacter pylori Eradication within 120 Days Is Associated with Decreased Complicated Recurrent Peptic Ulcers in Peptic Ulcer Bleeding Patients

Helicobacter pylori Eradication within 120 Days Is Associated with Decreased Complicated Recurrent Peptic Ulcers in Peptic Ulcer Bleeding Patients Gut and Liver, Vol. 9, No. 3, May 2015, pp. 346-352 ORiginal Article Helicobacter pylori Eradication within 120 Days Is Associated with Decreased Complicated Recurrent Peptic Ulcers in Peptic Ulcer Bleeding

More information

GERD, peptic ulcer disease, and celiac disease: updates from the upper GI tract

GERD, peptic ulcer disease, and celiac disease: updates from the upper GI tract GERD, peptic ulcer disease, and celiac disease: updates from the upper GI tract Primary Care Internal Medicine, October 15, 2018 Kyle Staller, MD, MPH Director, Gastrointestinal Motility Laboratory Center

More information

A bleeding ulcer: What can the GP do? Gastrointestinal bleeding is a relatively common. How is UGI bleeding manifested? Who is at risk?

A bleeding ulcer: What can the GP do? Gastrointestinal bleeding is a relatively common. How is UGI bleeding manifested? Who is at risk? Focus on CME at the University of British Columbia A bleeding ulcer: What can the GP do? By Robert Enns, MD, FRCP Gastrointestinal bleeding is a relatively common disorder affecting thousands of Canadians

More information

MECHANISMS OF HUMAN DISEASE: LABORATORY SESSIONS GASTROINTESTINAL (GI) PATHOLOGY LAB #1. January 06, 2012

MECHANISMS OF HUMAN DISEASE: LABORATORY SESSIONS GASTROINTESTINAL (GI) PATHOLOGY LAB #1. January 06, 2012 MECHANISMS OF HUMAN DISEASE: LABORATORY SESSIONS GASTROINTESTINAL (GI) PATHOLOGY LAB #1 GOAL: January 06, 2012 Faculty Copy 1. Describe the basis morphologic and pathophysiologic changes which occur in

More information

- Ali Yaghi. - Sara Yaghi. - Alia Shatnawi. 1 P a g e

- Ali Yaghi. - Sara Yaghi. - Alia Shatnawi. 1 P a g e -2 - Ali Yaghi - Sara Yaghi - Alia Shatnawi 1 P a g e We ended the previous lecture with H2 receptor antagonists, which work by selectively inhibiting H2 receptors. They are widely used to treat: 1- GERD,

More information

Disclosures. Proton Pump Inhibitors Deprescribing? Deprescribing PPI Objectives. Deprescribing. Proton Pump Inhibitors (PPI) 5/28/2018.

Disclosures. Proton Pump Inhibitors Deprescribing? Deprescribing PPI Objectives. Deprescribing. Proton Pump Inhibitors (PPI) 5/28/2018. Proton Pump Inhibitors Deprescribing? None Disclosures Chad Burski, MD Assistant Professor of Medicine UAB Gastroenterology Deprescribing PPI Objectives AR Why? Who? How? The mechanism of action of Proton

More information

Helicobacter pylori Eradication Therapy Success Regarding Different Treatment Period Based on Clarithromycin or Metronidazole Triple-Therapy Regimens

Helicobacter pylori Eradication Therapy Success Regarding Different Treatment Period Based on Clarithromycin or Metronidazole Triple-Therapy Regimens Helicobacter ISSN 1523-5378 Filipec Blackwell Oxford, HEL 1083-4389 1523-5378 Journal XXX Original H. 2008 pylori Kanizaj compilation The UK Eradication Publishing Article Authors et al. Ltd 2008 Therapy

More information

Helicobacter pylori:an Emerging Pathogen

Helicobacter pylori:an Emerging Pathogen Bacteriology at UW-Madison Bacteriology 330 Home Page Helicobacter pylori:an Emerging Pathogen by Karrie Holston, Department of Bacteriology University of Wisconsin-Madison Description of Helicobacter

More information