Unknown #115
Case Presentation <ul><li>A 59-year-old man has a 3-month history of epigastric discomfort and nausea without weight loss,...
<ul><li>Physical examination reveals mild epigastric tenderness to palpation. Upper endoscopy shows a 1-cm duodenal ulcer,...
Question <ul><li>Which of the following is the most appropriate therapy for this patient? </li></ul><ul><li>A)  proton pum...
Answer
Answer <ul><li>Which of the following is the most appropriate therapy for this patient? </li></ul><ul><li>A)  proton pump ...
Helicobacter Pylori Infection <ul><li>Estimated 30-40% of the U.S. population infected with H. Pylori </li></ul><ul><li>As...
ACG guidelines for diagnosis and testing <ul><li>Should be performed only if clinicians are planning to offer treatment wi...
“ Test-and-treat” strategy for certain patients: <ul><li>Uninvestigated dyspepsia less than 55 y.o. and without “alarm” sy...
 
Initial diagnostic workup <ul><li>Serum serology </li></ul><ul><li>Stool antigen (if patient is not actively bleeding, tak...
Treatment of H. Pylori <ul><li>Recommended therapy in the U.S. </li></ul><ul><ul><li>PPI + clarithromycin + amoxicillin or...
Follow up for eradication <ul><li>Urea breath test at least 4 weeks after therapy </li></ul><ul><li>Stool antigen testing ...
<ul><li>Chey, William et. al.  “American College of Gastroenterology Guideline on the Management of Helicobacter pylori in...
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Unknown #115

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Unknown #115

  1. 1. Unknown #115
  2. 2. Case Presentation <ul><li>A 59-year-old man has a 3-month history of epigastric discomfort and nausea without weight loss, melena, or vomiting. Over-the-counter H2-receptor antagonists have been ineffective. The patient is otherwise healthy and takes no other medications. </li></ul>
  3. 3. <ul><li>Physical examination reveals mild epigastric tenderness to palpation. Upper endoscopy shows a 1-cm duodenal ulcer, and antral biopsy specimens demonstrate chronic gastritis and Helicobacter pylori infection </li></ul>
  4. 4. Question <ul><li>Which of the following is the most appropriate therapy for this patient? </li></ul><ul><li>A) proton pump inhibitor for 2 months </li></ul><ul><li>B) An H2-receptor antagonist for 2 months </li></ul><ul><li>C) A proton pump inhibitor and amoxicillin for 2 weeks </li></ul><ul><li>D) A proton pump inhibitor, amoxicillin, and clarithromycin for 2 weeks </li></ul><ul><li>E) A proton pump inhibitor, amoxicillin, and clarithromycin for 2 months </li></ul>
  5. 5. Answer
  6. 6. Answer <ul><li>Which of the following is the most appropriate therapy for this patient? </li></ul><ul><li>A) proton pump inhibitor for 2 months </li></ul><ul><li>B) An H2-receptor antagonist for 2 months </li></ul><ul><li>C) A proton pump inhibitor and amoxicillin for 2 weeks </li></ul><ul><li>D) A proton pump inhibitor, amoxicillin, and clarithromycin for 2 weeks </li></ul><ul><li>E) A proton pump inhibitor, amoxicillin, and clarithromycin for 2 months </li></ul>
  7. 7. Helicobacter Pylori Infection <ul><li>Estimated 30-40% of the U.S. population infected with H. Pylori </li></ul><ul><li>Associated with upper GI conditions including chronic gastritis, peptic ulcer disease, and gastric malignancy </li></ul>
  8. 8. ACG guidelines for diagnosis and testing <ul><li>Should be performed only if clinicians are planning to offer treatment with a positive diagnosis </li></ul><ul><li>Active PUD, documented hx PUD, or gastric MALT lymphoma </li></ul>
  9. 9. “ Test-and-treat” strategy for certain patients: <ul><li>Uninvestigated dyspepsia less than 55 y.o. and without “alarm” symptoms </li></ul><ul><ul><li>Bleeding </li></ul></ul><ul><ul><li>Anemia </li></ul></ul><ul><ul><li>Early satiety </li></ul></ul><ul><ul><li>Unexplained weight loss </li></ul></ul><ul><ul><li>Progressive dysphagia </li></ul></ul><ul><ul><li>Odynophagia </li></ul></ul><ul><ul><li>Recurrent vomitting </li></ul></ul><ul><ul><li>Family hx of GI cancer </li></ul></ul><ul><ul><li>Previous esophagogastric malignancy </li></ul></ul>
  10. 11. Initial diagnostic workup <ul><li>Serum serology </li></ul><ul><li>Stool antigen (if patient is not actively bleeding, taking PPIs or bismuth) </li></ul><ul><li>Reserve endoscopic biopsy for those who are requiring diagnostic biopsy, or are having follow up endoscopy for gastric ulcer or suspected MALT lymphoma </li></ul>
  11. 12. Treatment of H. Pylori <ul><li>Recommended therapy in the U.S. </li></ul><ul><ul><li>PPI + clarithromycin + amoxicillin or metronidazole for 14 days </li></ul></ul><ul><ul><li>PPI or H2 blocker + bismuth + metronidazole + tetracycline for 10-14 days </li></ul></ul>
  12. 13. Follow up for eradication <ul><li>Urea breath test at least 4 weeks after therapy </li></ul><ul><li>Stool antigen testing 6 weeks after therapy, more widely available but not as accurate. </li></ul>
  13. 14. <ul><li>Chey, William et. al. “American College of Gastroenterology Guideline on the Management of Helicobacter pylori infection” American Journal of Gastroenterology . 2007; 102: 1808-1825. </li></ul>
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