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GI Disorders

Celiac Sprue
Diarrhea - Chronic
LGI Bleeding
UGI Bleeding
Hepatitis E
Malabsorption Syndrome
Acute Pancreatitis
Peptic Ulcer Disease
Reflux Esophagitis
Variceal Bleeding
Whipple's Disease

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Helicobacter pylori-associated Peptic Ulcers

Infection with H. pylori is a necessary cofactor for the overwhelming majority of duodenal and gastric ulcers not associated with NSAIDs; more than 90% of patients with duodenal ulcer have H. pylori chronic gastritis.

The natural history of peptic ulcer disease is well defined. After standard therapy with H2-antagonists or sucralfate, 70% to 85% of affected patients per year have a recurrence. One half of these are asymptomatic.

Patients with active ulcers should have antral biopsies taken at endoscopy. If histologic examination shows normal mucosa, NSAIDs or hypersecretory states are more likely possibilities than H. pylori infection. However, because approximately one half of patients taking chronic NSAID therapy who develop ulcers also have chronic H. pylori gastritis, the cause of the ulcer may be unclear.

The optimal regimen a 14-day course of

  • Pepto-bismuth/ BSS, 2 tablets four times a day;
  • metronidazole, 250 mg four times a day; and
  • tetracycline, 500 mg four times a day
    eradicates the organism in >85% of treated patients.
    Failure of triple therapy is usually the result of noncompliance or metronidazole resistance. Side effects including nausea, vomiting, and diarrhea occur in up to one third of patients given triple therapy, potentially limiting patient tolerance and compliance. Nevertheless, triple therapy remains the gold standard for eradication.

The current 10-day regimen with

  • Omeprazole/Prilosec 20 mg  BID
  • Clarithromycin 500 mg BID
  • Metronidazole 500 mg BID
    has 87-91% cure.

ACP Library on Disk 2- (c) 1997 - American College of Physicians