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Q1: ANSWER: B
Critique
This patient has developed an ulcer because of chronic NSAID use. She is older than 60 years old and is also on antiplatelet therapy. Therefore, her risk of peptic ulcer rebleeding is high and warrants lifelong secondary prophylaxis with a proton pump inhibitor (Choice B). Therefore, stopping all prophylactic measures would be inappropriate (Choice A). Repeat endoscopy to assess for gastric ulcer healing may be warranted, especially in the setting of risk factors for malignancy, but duodenal ulcers do not require endoscopic follow-up (Choice C). There is no role to empirically treat H. pylori in the context of having negative test results (Choice E).
References
1. Bhatt, D.L., et al. ACCF/ACG/AHA 2008 Expert Consensus Document on Reducing the Gastrointestinal Risks of Antiplatelet Therapy and NSAID Use. Am. J. Gastroenterol. 2008;103:2890-907.
2. Abraham, N., et al. ACCF/ACG/AHA 2010 Expert Consensus Document on the Concomitant Use of Proton Pump Inhibitors and Thienopyridines: A Focused Update of the ACCF/ACG/AHA 2008 Expert Consensus Document on Reducing the Gastrointestinal Risks of Antiplatelet Therapy and NSAID Use. J. Am. Coll. Cardiol. 2010;56:2051-66.
Q1: ANSWER: B
Critique
This patient has developed an ulcer because of chronic NSAID use. She is older than 60 years old and is also on antiplatelet therapy. Therefore, her risk of peptic ulcer rebleeding is high and warrants lifelong secondary prophylaxis with a proton pump inhibitor (Choice B). Therefore, stopping all prophylactic measures would be inappropriate (Choice A). Repeat endoscopy to assess for gastric ulcer healing may be warranted, especially in the setting of risk factors for malignancy, but duodenal ulcers do not require endoscopic follow-up (Choice C). There is no role to empirically treat H. pylori in the context of having negative test results (Choice E).
References
1. Bhatt, D.L., et al. ACCF/ACG/AHA 2008 Expert Consensus Document on Reducing the Gastrointestinal Risks of Antiplatelet Therapy and NSAID Use. Am. J. Gastroenterol. 2008;103:2890-907.
2. Abraham, N., et al. ACCF/ACG/AHA 2010 Expert Consensus Document on the Concomitant Use of Proton Pump Inhibitors and Thienopyridines: A Focused Update of the ACCF/ACG/AHA 2008 Expert Consensus Document on Reducing the Gastrointestinal Risks of Antiplatelet Therapy and NSAID Use. J. Am. Coll. Cardiol. 2010;56:2051-66.
Q1: ANSWER: B
Critique
This patient has developed an ulcer because of chronic NSAID use. She is older than 60 years old and is also on antiplatelet therapy. Therefore, her risk of peptic ulcer rebleeding is high and warrants lifelong secondary prophylaxis with a proton pump inhibitor (Choice B). Therefore, stopping all prophylactic measures would be inappropriate (Choice A). Repeat endoscopy to assess for gastric ulcer healing may be warranted, especially in the setting of risk factors for malignancy, but duodenal ulcers do not require endoscopic follow-up (Choice C). There is no role to empirically treat H. pylori in the context of having negative test results (Choice E).
References
1. Bhatt, D.L., et al. ACCF/ACG/AHA 2008 Expert Consensus Document on Reducing the Gastrointestinal Risks of Antiplatelet Therapy and NSAID Use. Am. J. Gastroenterol. 2008;103:2890-907.
2. Abraham, N., et al. ACCF/ACG/AHA 2010 Expert Consensus Document on the Concomitant Use of Proton Pump Inhibitors and Thienopyridines: A Focused Update of the ACCF/ACG/AHA 2008 Expert Consensus Document on Reducing the Gastrointestinal Risks of Antiplatelet Therapy and NSAID Use. J. Am. Coll. Cardiol. 2010;56:2051-66.