Question

A 54-year-old woman presented with a 1-month history of intermittent, burning epigastric abdominal pain that was moderately severe in intensity. Her pain radiated toward her back in a band-like fashion. She also noted nausea and vomited once, with the vomit consisting of food particles. The patient denied having signs and symptoms of melena, hematochezia, or hematemesis. Her medical history was significant for peptic ulcer disease, and the patient had had multiple endoscopies in the past 6 years. It was learned that she had 2 clean-based antral ulcers 5 years prior and was started on lansoprazole, which she could not afford and so was switched to omeprazole, which she used intermittently. She also admitted to past use of an over-the-counter analgesic consisting of acetaminophen, aspirin, and caffeine. This patient should be discharged on what medication? Explain why you are choosing them. What would be Non Pharmacological approach for the treatment of this patient ?

Answer 1

Based on the history the diagnosis of peptic ulcer disease (PUD) seems most appropriate. She also had previous history of PUD, hence underwent endoscopy.

Following medication can be prescribed depending on scenario

• Antibiotic medications to kill H. pylori. If H. pylori is found in your digestive tract, the treatment may include amoxicillin, clarithromycin, metronidazole, tinidazole, tetracycline and levofloxacin..

• Medications that block acid production and promote healing. Proton pump inhibitors — also called PPIs — reduce stomach acid by blocking the action of the parts of cells that produce acid. These drugs include the prescription and over-the-counter medications omeprazole, lansoprazole, rabeprazole and other PPIs

• Medications to reduce acid production. Acid blockers — also called histamine (H-2) blockers — reduce the amount of stomach acid released into your digestive tract, which relieves ulcer pain and encourages healing.

• Antacids that neutralize stomach acid. Your doctor may include an antacid in your drug regimen. Antacids neutralize existing stomach acid and can provide rapid pain relief. Side effects can include constipation or diarrhea, depending on the main ingredients.

• Medications that protect the lining of your stomach and small intestine. In some cases, your doctor may prescribe medications called cytoprotective agents that help protect the tissues that line your stomach and small intestine

non pharmacological approach includes avoidance of spicy and fatty foods, having an early dinner so as to allow the food to digest, having small frequent meals. In addition to this avoid alcohol and tobacco intake as they erode the gastric lining as cause PUD. Avoid intake of NSAID's which can cause PUD. Identify your stressors and avoid them as this could lead to stress related ulcers.