内科学消化性溃疡钟良_培训课件.ppt

Treatment– H. pylori eradication Triple therapy for 14 days is considered the treatment of choice. Proton Pump Inhibitor + clarithromycin and amoxicillin Omeprazole (Prilosec): 20 mg PO bid for 14 d orLansoprazole (Prevacid): 30 mg PO bid for 14 d orRabeprazole (Aciphex): 20 mg PO bid for 14 d orEsomeprazole (Nexium): 40 mg PO qd for 14 d plusClarithromycin (Biaxin): 500 mg PO bid for 14 andAmoxicillin (Amoxil): 1 g PO bid for 14 d Can substitute Flagyl 500 mg PO bid for 14 d if allergic to PCN In the setting of an active ulcer, continue qd proton pump inhibitor therapy for additional 2 weeks. Treatment– H. pylori eradication Quadruple therapy for the infection of resistant organism Omeprazole 20mg qd Bismuth subsalicylate 2 tablets qid Metronidazole 250mg qid Tetracycline 500mg qid Goal: complete elimination of H. Pylori. Once achieved re-infection rates are low. Compliance! Treatment— NSAID related PUD Prevention! H2RA PPI Misoprostol Selective COX-2 inhibitors H. pylori eradication Treatment– cytoprotective agents Sucralfate Bismuth-Containing Preparations Prostaglandin Analogues GU active to healed DU active to healed Lifestyle Changes Discontinue NSAIDs and use Acetaminophen for pain control if possible. Acid suppression--Antacids Smoking cessation No dietary restrictions unless certain foods are associated with problems. Alcohol in moderation Men under 65: 2 drinks/day Men over 65 and all women: 1 drink/day Stress reduction Prevention Consider prophylactic therapy for the following patients: Pts with NSAID-induced ulcers who require daily NSAID therapy Pts older than 60 years Pts with a history of PUD or a complication such as GI bleeding Pts taking steroids or anticoagulants or patients with significant comorbid medical illnesses Prophylactic regimens that have been shown to dramatically reduce the risk of NSAID-induced gastric and duodenal ulcers inclu