Today's Pearl
Sunday August 18, 2019
Sunday August 18, 2019
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 to a certain surprise, 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.
#gastroenterology
#pharmacology
References:
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.