Cash quadrant12/6/2023 The majority of patients with PUD present to their primary caregiver, but others may present to the emergency department, urgent care clinic, or an outpatient clinic. When left untreated, it has significant morbidity. PUD is a very common disorder that affects millions of people. Īn evidence-based approach to peptic ulcer disease is recommended. Surgical options include vagotomy or partial gastrectomy. If the ulcer persists despite addressing the above risk factors, patients can be candidates for surgical treatment. The common causes are persistent H.pylori infection, continued use of NSAIDs, or significant comorbidities that impair ulcer healing or other conditions like gastrinoma or gastric cancer. A refractory peptic ulcer is one over 5 mm in diameter that does not heal despite 8-12 weeks of PPI therapy. Surgical treatment is indicated if the patient is unresponsive to medical treatment, noncompliant, or at high risk of complications. Refractory Disease and Surgical Treatment If first-line therapy fails, quadruple therapy with bismuth and different antibiotics is used. The antibiotic selected should take into consideration the presence of antibiotic resistance in the environment. Antibiotics and PPIs work synergistically to eradicate H. Pantoprazole, clarithromycin, and metronidazole, or amoxicillin are used for 7 to 14 days. pylori-induced PUD is a triple regimen comprising two antibiotics and a proton pump inhibitor. Prostaglandin analogs (misoprostol) are sometimes used as prophylaxis for NSAID-induced peptic ulcers. Corticosteroids, bisphosphonates, and anticoagulants should also be discontinued if possible. NSAIDs induced PUD can be treated by stopping the use of NSAIDs or switching to a lower dose. Treatment may be incorporated with calcium supplements as long-term use of the PPIs can increase the risk of bone fractures. PPIs block acid production in the stomach, providing relief of symptoms and promote healing. PPIs have largely replaced H2 receptor blockers due to their superior healing and efficacy. Antisecretory drugs used for peptic ulcer disease (PUD) include H2-receptor antagonists and the proton pump inhibitor (PPIs).
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