G.I. Updt Case Studies

Key Concepts:

Terms in this set (12)

3. Answer: C
The test-and-treat approach is appropriate in dyspeptic patients thought to have H. pylori infections. Patients older than 45-55 years, or those with alarm features, should be referred for endoscopic evaluation to rule out the possibility of a more complicated disease. Ambulatory patients can be tested for H. pylori using various diagnostic approaches (e.g., UBT). The eradication of H. pylori leads to high rates of ulcer healing and minimizes ulcer recurrence. According to treatment guidelines, eradication regimens for H. pylori infection should include at least two antibiotics plus an antisecretory agent given for 10-14 days. This can be accomplished with triple-drug therapies containing amoxicillin (or metronidazole) plus clarithromycin in addition to a PPI. Likewise, quadruple therapy with bismuth, tetracycline, metronidazole, and a PPI can be used first line in penicillin-allergic patients or as a secondline
treatment of initial failures of triple-drug therapy.
This patient requires treatment secondary to a positive test. Because he reports a penicillin allergy, Answer A would not be appropriate. Answer B would not be viable because cephalosporins are not recommended in H.
pylori treatment regimens. Answer D would be incorrect because fluoroquinolone-based regimens should be reserved as salvage therapy for patients whose triple and quadruple therapy has failed, making Answer C correct; quadruple therapy offers similar efficacy and is a viable option in penicillin-allergic patients. Patient
adherence should be reinforced to maximize efficacy.