Question
A 52-year-old woman is experiencing abdominal discomfort after meals as well as early in the morning. There is no weight loss or constitutional symptoms, and she has tried antacids but experienced minimal relief. Upper endoscopy reveals a duodenal ulcer and the biopsy is negative for malignancy. Which of the following is the most appropriate next step in management?
| A. |
6–8 weeks of omeprazole or ranitidine
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| B. |
long-term acid suppression with omeprazole
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| C. |
antibiotic therapy
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| D. |
antibiotic therapy with omeprazole
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Show Answer
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Correct Answer � D
Explanation
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Ans. (D)
Eradication of H. pylori is the most effective treatment for duodenal ulcer disease. The most popular regimes include antibiotics and acid suppression medications.
Helicobacter pylori are very sensitive to amoxicillin both in vivo and in vitro.
Like other penicillins, amoxicillin works by inhibiting bacterial cell wall synthesis, leading to cell death.
More than 2 g a day of amoxicillin does not increase its eradication rate of H pylori when used as a single agent.
However, when it is given in combination with omeprazole, the concentration of amoxicillin in the gastric juice and its eradication efficacy increase significantly.
It is hypothesized that this eradication enhancement comes about by omeprazole decreasing gastric secretions, thus increasing the intragastric concentration of amoxicillin to more than the minimal inhibitory concentration (MIC) of H pylori, as well as decreasing the MIC of amoxicillin by increasing the gastric pH.
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