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Transcript
Internal Medicine
B) H 2 receptor antagonists
• Include cimetidine, famotidine, ranitidine and nizatidine.
• Cimetidine is the most commonly used drug. The dose is 800 mg at bedtime or
400mg twice a day for 4 - 6 weeks.
• Ranitidine is used at a dose of 150 mg orally twice a day or 300mg at bedtime for
4 – 6 wks.
C) Proton pump inhibitors
• They inhibit the H+-pump, which is important for synthesis of hydrochloric acid.
• Omeperazole: 20mg orally daily for 4 - 8 weeks.
• When these drugs are used for anti- H. pylori treatment, it has direct antimicrobial
effect on the organism.
D) Dietary advice
• There is no specific diet recommended for patients with peptic ulcer disease.
• Patients are generally advised to avoid smoking, coffee, and foods that cause or
aggravate their symptoms.
Surgical treatment is indicated for:
•
Perforation: immediate surgery is recommended for acute perforation. If this is not
possible, admit the patient to ICU and put on continuous nasogastric suction and
broad-spectrum antibiotics.
N.B.
•
Obstruction not responding to medical therapy
•
Uncontrolled/recurrent bleeding
•
Suspected malignancy
•
Symptoms refractory to medical management
For the types of surgical procedures and their complications, please refer Surgical
textbooks.
Dyspepsia
•
Is the classic symptom of PUD and is defined as pain centered in the upper
abdomen or discomfort characterized by fullness, bloating, distension or nausea.
•
It’s a common clinical problem and may be seen in 25 - 40% of adults.
•
Only 15 - 25% patients with dyspepsia are found to have either gastric or duodenal
ulcers.
•
Other causes include:
ο
Gastroesophageal reflux disease
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