Peptic ulcer disease caused by H. pylori

Full Answer Section

References:

1. Chey WD, Kim DY, Bang JY, et al. ACG Clinical Guideline: Treatment of Peptic Ulcer Disease. American Journal of Gastroenterology. 2017;112(2):280-288. doi:10.1038/ajg.2016.522
2. Malfertheiner P, Megraud F, Graham DY, et al. European Society of Gastrointestinal Endoscopy (ESGE) Guideline for the diagnosis and management of Helicobacter pylori infection. Endoscopy. 2017;49(Suppl 1):1-55. doi:10.1055/s-0043-118214

Sample Solution

Initial Management Plan for H. pylori-positive Peptic Ulcer Disease (PUD)

The initial management plan for Mike, a 46-year-old with H. pylori-positive PUD based on a positive serum test, involves a triple therapy eradication regimen targeting the bacteria. This approach is recommended by major guidelines due to its high efficacy and established safety profile [1, 2].

Typical triple therapy includes:

• Proton pump inhibitor (PPI): This reduces stomach acid production, providing symptom relief and promoting ulcer healing. Options include omeprazole, lansoprazole, pantoprazole, rabeprazole, or esomeprazole.
• Two antibiotics: These target and eradicate H. pylori. Commonly used combinations include amoxicillin and clarithromycin, or amoxicillin and metronidazole. The specific antibiotic choice may depend on local resistance patterns and individual patient factors.
• Bismuth subsalicylate (Pepto-Bismol): This can be added in some cases to improve treatment effectiveness, although it may not be suitable for everyone.

The treatment duration typically lasts 14 days, and specific instructions on medication administration and potential side effects will be provided by the healthcare professional.

Additional considerations:

• Lifestyle modifications: Avoiding smoking, limiting alcohol consumption, and maintaining a healthy diet can improve treatment outcomes and prevent future PUD recurrence.
• Re-evaluation: After completing therapy, a follow-up test will be conducted to ensure successful H. pylori eradication.