Mr. Jones is a 45 year old male who presents to your clinic with epigastric abdominal pain x 2 weeks. He describes it as a burning pain which is non-radiating and is worse after he eats. He has frequent belching with bloating sensation but denies nausea, vomiting, diarrhea, constipation, or weight loss. He has tried rolaids which do help a little.
Which symptoms support the possible diagnosis of PUD?
On further questioning Mr. Jones states he had similar abdominal pain three years ago and was told by his physician at that time that it was most likely due to an ulcer. He took “the purple pill” for a month and his symptoms resolved. He had no definitive diagnostic tests done at that time.
Two forms of triple therapy: PPI–based and bismuth-based
PPI based = PPI + 2 antibiotics for 2 wk, cont PPI for additional 2 weeks.
Bismuth-based = bismuth subsalicylate and 2 antibiotics, for 2 weeks with addition of H2- blocker to optimize ulcer healing.
H Pylori Treatment http://www.drugdigest.org/DD/Comparison/NewComparison/0,10621,550540-21,00.html Cure Rate Side Effect Rating 81-92% low-medium Prevpak 80-85% medium-high Helidac + H2 blocker Combination Products 80-90% medium Amoxicillin + Metronidazole + PPI 80-90% medium-low Amoxicillin + Clarithromycin + PPI 80-90% medium Clarithromycin + Metronidazole + PPI Three Drug Regimens
Mr Jones is a 63 yo male presenting with previously noted epigastric symptoms and PMH. On review of his prior ulcer history he was tested and had a positive H. pylori serology test. He was treated with triple therapy (PPI and 2 antibiotics) and symptoms resolved.
What would you do next? Would you recheck H. pylori serology? Repeat triple therapy?