Monday, August 19, 2019

NSAID induced peptic ulcer

Q: 32 year old athletic male is admitted to ICU with bleeding peptic ulcer due to overuse of Non-Steroidal-Anti-Inflammatory-Drugs (NSAIDs). Which of the following regimen would be most effective? 

A) Proton Pump Inhibitors (PPIs) 
B) Histamine 2- Receptor-Blockers (H2-R-B) 
C) Combine PPI and H2-R-blocker 
D) Sucralfate 
E) Milk of Magnesia (MoM)

Answer: A

NSAID-induced peptic ulcers are best treated with PPIs. Interestingly and surprisingly combine PPI and H2-R-B failed to show any synergistic or added advantage. Similarly, all other modalities were found inferior to PPI in the treatment of NSAID induced peptic ulcer.



Yeomans ND, Tulassay Z, Juhász L, et al. A comparison of omeprazole with ranitidine for ulcers associated with nonsteroidal antiinflammatory drugs. Acid Suppression Trial: Ranitidine versus Omeprazole for NSAID-associated Ulcer Treatment (ASTRONAUT) Study Group. N Engl J Med 1998; 338:719. 

Blum AL, Bethge H, Bode JC, et al. Sucralfate in the treatment and prevention of gastric ulcer: multicentre double blind placebo controlled study. Gut 1990; 31:825.

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