PPIs and H Pylori By Julie Fitzwilliam Zara

PPI’s and H. Pylori By: Julie Fitzwilliam & Zara Mahamat

What Is H. Pylori? • Is bacteria that attacks the lining of the stomach weakening it. • Once the bacteria has done enough damage, acid can get through the lining, which leads to ulcers. The ulcers can cause bleeding and infection. • H. pylori is linked to gastritis, gastric ulcers and stomach cancer. • Common symptoms of H. pylori: Abd pain, hematemesis, dark stools, nausea, vomiting, and heartburn.

Case Study History Exam Findings • A 45 year old Caucasian female presents with epigastric • On examination, abdomen was soft and pain for 3 weeks and intermittent acid reflux. She denies signs and symptoms of melena, hematochezia, or hematemesis. Denies using anything for pain relief • PMH: HTN, osteoarthritis and treatment of a ulcer 4 years ago • Medication: Lisinopril 20 mg daily and Motrin PRN • SH: Married, smokes ½ pack a day for 20 years, occasional ETOH use • NKDA , ROS: denies nausea, vomiting, diarrhea, fevers and weight loss has frequent belching with bloating sensation non-distended, bowel sounds present X 4 quadrants, tenderness over the epigastrium. • Basic lab findings normal with Hemoglobin 6 • EGD showed bleeding ulcers, biopsy was collected reveling H. pylori

Treatment • Treatment is aimed to reduce stomach acidity and treatment of H. pylori infection. • No single medication gets rid of H. pylori • Therapy typically consist of a triple or quadruple combination for 2 weeks • Triple: PPI & 2 ABX x 14 days • Quadruple: PPI & 3 ABX x 14 days • A PPI should always be used in either a dual or triple combination therapy. They help to promote gastric healing, prevent recurrence of duodenal and gastric ulcers, and reduce the incidence of gastric cancer.

Treatment Options Triple Therapy • PPI (standard or double dose)orally twice daily + Clarithromycin 500 mg orally twice daily + Amoxicillin 1 gm twice daily or Metronidazole (if PCN allergy) 500 mg orally three times daily (for 14 days) Bismuth Quadruple Therapy • PPI (standard dose) twice daily + Bismuth subcitrate 300 mg or 525 mg four times a day+ tetracycline 500 mg four times a day + metronidazole 250 mg or 500 mg four times day (1014 days)

Standard PPI Dosing • Lansoprazole 30 mg twice daily • Omeprazole 20 mg twice daily • Pantoprazole 40 mg twice daily • Rabeprazole 20 mg twice daily • Esomeprazole 20 mg twice daily or 40 mg once daily

Patient Education & Prescription Tiffany Fitzwilliam 1875 S 300 E SLC, UT 84115 801 -0000 • Take all your medication to prevent resistances. • Take your pantoprazole 30 minutes before meals. Name: Jane Doe Birthdate: 2/22/1972 Date: 9/10/17 Rx: Pantoprazole 40 mg BID, Bismuth subcitrate 300 mg QID, tetracycline 500 mg QID, metronidazole 250 mg QID for 14 days for H. pylori infection ____________ Signature Refill: 0 times DEA#______

References: • Katzung, Bertram. (2015). Basic and Clinical Pharmacology. 13 th ed. New York, NY: Lange Medical Books/Mc. Graw-Hill • Crowe, S. E. (2017, July 26). Treatment regimens for Helicobacter pylori. Retrieved November 07, 2017, from https: //www. uptodate. com/contents/treatment-regimens-forhelicobacter-pylori? source=see_link • Drugs for Helicobacter pylori Infection. (2017). The Medical Letter, 59(1525), 113 -118.