Pharmacology

MD 4

Peptic Ulcer

Dr. Gurung Shantil

Meyof Sabeth M. T.

March 14, 2022.

Question

A 45-year-old male patient presents with dyspepsia and dull epigastric pain which has been

worsening gradually over the last one month. The pain is partly relieved by food but becomes

worse after 2 hours or so. Heartburn and pain which awakens him are often felt at night.

Epigastric tenderness is detected on palpation. Upper gastrointestinal endoscopy reveals an ulcer

measuring 12 mm X 18 mm in the 1st part of the duodenum. His medical records show that he

suffered a similar episode of pain about 9 months ago. No endoscopy was done, but he was

treated with omeprazole 20 mg OD for 6 weeks. Subsequently, nearly 3 months back, he suffered

from loose motions and abdominal pain which was treated with a 5-day course of metronidazole

+ norfloxacin. The facility for H. pylori testing is not available. There is no history of NSAID

use.

 What would be the most appropriate treatment option for him to achieve fast symptom

relief, ulcer healing and prevention of further recurrences?

 Answer

Though H. pylori testing hasn’t been done, it is safe to assume that the patient’s peptic ulcer

disease is caused by H. pylori.

For rapid alleviation of pain, the patient should be placed on antacid.

For ulcer healing and prevention of further recurrence, the patient should be placed on triple

peptic ulcer therapy with;

1. Omeprazole; functions by irreversibly inhibiting the proton pump hence used as an

eradication regimen in H. pylori. Hence function in healing the ulcer.

2. Amoxicillin; a penicillin effective in the management of H. pylori

3. Clarithromycin; a macrolide also very effective in the eradication of H. pylori.

The antibiotics are important in preventing reoccurrence of the infection since they

destroy the microbe causing the presentation of PUD,