Peptic Ulcer Disease (PUD) and Gastritis

Answer Explanation:

• Clarithromycin is the correct answer because it is one of the antibiotics commonly used in the treatment of Helicobacter pylori peptic ulcer disease. The standard treatment regimen for H. pylori infection includes a proton pump inhibitor (like omeprazole) and two antibiotics (usually clarithromycin and amoxicillin or metronidazole), taken for 7-14 days.
• Vancomycin, Flucloxacillin, Cefuroxime, and Ciprofloxacin are all antibiotics, but they are not typically used in the treatment of H. pylori infections.

Overview of Helicobacter pylori Peptic Ulcer Disease:

Etiology:

• Peptic ulcer disease is most commonly caused by Helicobacter pylori infection or nonsteroidal anti-inflammatory drug (NSAID) use.
• H. pylori is a gram-negative, spiral-shaped bacterium that can colonize the stomach and duodenum, leading to chronic inflammation and peptic ulcers.

Clinical Presentation:

• Patients with H. pylori peptic ulcer disease may present with epigastric pain, nausea, bloating, early satiety, and in severe cases, gastrointestinal bleeding.

Diagnosis:

• Diagnosis can be confirmed by several methods, including urea breath test, stool antigen test, or endoscopic biopsy.

Treatment:

• Treatment typically involves a combination of a proton pump inhibitor and two antibiotics to eradicate the bacteria, reduce gastric acid production, and promote ulcer healing.
• Clarithromycin, in combination with amoxicillin or metronidazole, is commonly used.

Answer Explanation:

• The correct answer is Gallstones. Gallstones are not known to be a risk factor for peptic ulcers. They are associated with gallbladder disease and can cause symptoms such as abdominal pain, but they do not contribute to the development of peptic ulcers.
• Naproxen, a nonsteroidal anti-inflammatory drug (NSAID), is a known risk factor for peptic ulcers. NSAIDs can cause stomach irritation and lead to the development of ulcers.
• Alcohol is also a risk factor for peptic ulcers. It can damage the stomach lining and increase stomach acid production, both of which can lead to ulcers.
• Prednisolone, a type of steroid medication, can increase the risk of peptic ulcers. Steroids can increase stomach acid production and decrease the protective mucus in the stomach, leading to ulcers.
• Smoking is another risk factor for peptic ulcers. It can increase stomach acid production and decrease blood flow to the stomach lining, both of which can lead to ulcers.

Overview of Peptic Ulcers:

• Peptic ulcers are open sores that develop on the inside lining of the stomach, upper small intestine or esophagus.
• The most common symptom of a peptic ulcer is burning abdominal pain that extends from the navel to the chest, which can be worse when the stomach is empty, at night, or a few hours after meals.
• Other symptoms can include changes in appetite, unexplained weight loss, nausea, bloody or dark stools, and vomiting.
• Peptic ulcers occur when acid in the digestive tract eats away at the inner surface of the stomach or small intestine. The acid can create a painful open sore that may bleed.
• Common causes of peptic ulcers include long-term use of NSAIDs, like aspirin and ibuprofen, and an infection with the bacterium Helicobacter pylori (H. pylori).
• Less common causes of peptic ulcers include certain other medications, smoking, alcohol, and severe stress.

Answer Explanation:

• The correct answer is ‘The risk of acquiring H. pylori infection declines after childhood’. This is because H. pylori infection is usually acquired in childhood and the prevalence of infection increases with age. However, the risk of acquiring new infections declines after childhood.

Incorrect Options Explanation:

• ‘There is no association between socioeconomic status and H. pylori infection’ – This statement is incorrect. There is a well-established association between lower socioeconomic status and higher prevalence of H. pylori infection.
• ‘Gastric ulcers are more common than duodenal ulcers’ – This statement is incorrect. Duodenal ulcers are more common than gastric ulcers.
• ‘The pain of gastric ulcers is classically relieved by eating’ – This statement is incorrect. The pain of duodenal ulcers, not gastric ulcers, is classically relieved by eating.
• ‘The Zollinger–Ellison syndrome has no known cause’ – This statement is incorrect. Zollinger-Ellison syndrome is caused by a gastrin-secreting tumor, usually located in the pancreas or duodenum.

Overview of Peptic Ulcer Disease:

• Peptic ulcer disease refers to painful sores or ulcers in the lining of the stomach or the first part of the small intestine, the duodenum.
• Common causes include long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) and an infection with the bacterium H. pylori.
• Less common causes include smoking, severe stress, and Zollinger-Ellison syndrome.
• Symptoms include a burning pain in the stomach, bloating, heartburn, nausea or vomiting, and dark or black stool.
• Diagnosis is typically by endoscopy or an upper GI series.
• Treatment includes stopping NSAIDs, eradicating H. pylori, and taking proton pump inhibitors.