Reply to my peers

Peer 2

1.      What would you prescribe initially?

 

Patients suffering from gastric ulcers with a Helicobacter pylori infection are recommended to start a stand triple therapy as a first-line treatment, including a PPI and two antibiotics (Woo & Robinson, 2020). Based on these treatment protocols, I would initially prescribe pantoprazole 40mg BID, clarithromycin 500mg bid, and amoxicillin 1g BID (Woo & Robinson, 2020).

 

2.      How long would you prescribe these medications?

 

I would prescribe the patient to take these medications together for a total of 14 days and to continue with the PPI for 4-6 weeks (Thomas, 2019).

 

3.      What other possible meds could you prescribe to assist with the side effects from the medications prescribed?

 

Studies have shown that adding a probiotic to the therapy will positively impact the side-effects related to antibiotics such as diarrhea and taste disturbances while also improving eradication rates of H. Pylori (Tong et al., 2017). Thus, I would prescribe Lacto acidophilus to the treatment regime.

 

4.      How would the treatment vary if the patient has GERD instead?

 

The situation would vary if the patient were only to be experiencing GERD based on no longer attempting to eradicate H. Pylori; instead, the goal would be to give the patient rapid relief of symptoms while preventing further complications. Based on ACG recommendations, the patient would be educated on lifestyle modifications that include weight loss, remaining upright following a meal, and avoiding trigger food (e.g, alcohol, caffeine, acidic or spice, and chocolate) (Thomas, 2019). Also, additional pharmacological treatments would be based on the symptoms. Using the stepped approach, I would recommend starting an 8-week trial of PPIs and taking the medication 30-60 weeks before a meal (Thomas, 2019).

 

GERD symptoms are very similar to other gastrointestinal diseases, and the diagnosis is made based on history alone. Differential diagnoses include peptic ulcer disease (PUD) and gallbladder disease (Thomas, 2019). Symptoms with GERD typically correlate the most with peptic ulcer disease. Both conditions present with epigastric pain; however, a hallmark sign indicative of PUD is the relief of burning after food or antacid intake (Thomas, 2019). Instead, symptoms are often worsened by food or an antacid intake with GERD. Gallbladder disease also typically presents with epigastric pain or right subcostal pain with nausea or vomiting related to cholelithiasis, which is not the case with GERD. Based on the patients presenting symptoms and positive h. pylori test, it is appropriate to say that the patient is experiencing PUD rather than GERD. For most patients, the stepped approach is used for GERD treatment, which is based on symptom relief and the degree of esophageal damage (Woo & Robinson, 2020). PPIs and histamine 2 receptor agonists have been seen to provide the best management for GERD. Histamine2- receptor agonists inhibit gastric secretion while PPI suppresses gastric acid secretion (Woo& Robinson, 2020). As mentioned earlier, GERD is diagnosed based on symptoms and response to medication therapy. If individuals do not respond to the 8-week PPI regime, the following diagnostic test would be an esophagogastroduodenoscopy (EGD) to directly visualize the intestinal mucosa and the extent of tissue damage (Thomas, 2019).

 

References 

Tong, J. L., Ran, Z. H., Shen, J., Zhang, C. X., & Xiao, S. K. (2006). Meta-analysis: The effect of supplementation with probiotics on eradication rates and adverse events during Helicobacter pylori eradication therapy. Alimentary Pharmacology & Therapeutics, 25, 155–168

 

Thomas, D. J. (2019).  Gastric and Intestinal Disorders. In L. M. Dunphy, J. E. Winland, B. O. Porter, & D. J. Thomas (Eds.), Primary Care: Art and Science of Advanced Practice Nursing- An Interprofessional Approach, (5th eds., pp 571-603). F. A Davis