Peptic ulcer treatment: pharmacology of drugs Eradication therapy Once the diagnosis of H. pylori is confirmed, the first-line treatment would be a triple regimen in which pantoprazole and clarithromycin are combined with either amoxicillin or metronidazole. This treatment regimen can be given for 7–14 days. However, its effectiveness in eradicating H. pylori has been reducing from 90% to 70%. However, the rate of eradication can be increased by doubling the dosage of pantoprazole or increasing the duration of treatment to 14 days. Quadruple therapy (pantoprazole, clarithromycin, amoxicillin, and metronidazole) can also be used. The quadruple therapy can achieve an eradication rate of 90%. If the clarithromycin resistance rate is higher than 15% in an area, the usage of clarithromycin should be abandoned. Instead, bismuth-containing quadruple therapy can be used (pantoprazole, bismuth citrate, tetracycline, and metronidazole) for 14 days. The bismuth therapy can also achieve an eradication rate of 90% and can be used as second-line therapy when the first-line triple-regimen therapy has failed NSAIDs induced ulcers NSAID-associated ulcers heal in 6 to 8 weeks provided the NSAIDs are withdrawn with the introduction of proton pump inhibitors (PPI).<unk>  For those with<unk>  peptic ulcers, fluid replacement with crystalloids is sometimes given to maintain volume in the blood vessels. Maintaining haemoglobin at greater than 7 g/dL (70 g/L) through restrictive blood transfusion has been associated with reduced rate of death. Glasgow-Blatchford score is used to determine whether a person should be treated inside a hospital or as an outpatient. Intravenous PPIs can suppress stomach<unk>  more quickly than oral ones. A neutral stomach pH is required to keep platelets in place and prevent clot lysis. Tranexamic acid and antifibrinolytic agents are not useful in treating peptic ulcer disease. Early endoscopic therapy can help to stop<unk>  by using cautery, endoclip, or epinephrine injection. Treatment is indicated if there is active<unk>  in the stomach, visible vessels, or an adherent clot. Endoscopy is also helpful in identifying people who are suitable for hospital discharge. Prokinetic agents such as erythromycin and metoclopramide can be given before endoscopy to improve endoscopic view. Either high- or low-dose PPIs are equally effective in reducing<unk>  after endoscopy. High-dose intravenous PPI is defined as a bolus dose of 80 mg followed by an infusion of 8 mg per hour for 72 hours—in other words, the continuous infusion of PPI of greater than 192 mg per day. Intravenous PPI can be changed to oral once there is no high risk of rebleeding from peptic ulcer. For those with hypovolemic shock and ulcer size of greater than 2 cm, there is a high chance that the endoscopic treatment would fail. Therefore, surgery and angiographic embolism are reserved for these complicated cases. However, there is a higher rate of complication for those who underwent surgery to patch the stomach<unk>  site when compared to repeated endoscopy. Angiographic embolisation has a higher rebleeding rate but a similar rate of death to surgery. Anticoagulants According to expert opinion, for those who are already on anticoagulants, the international normalized ratio (INR) should be kept at 1.5. For aspirin users who required endoscopic treatment for<unk>  peptic ulcer, there is two times increased risk of rebleeding but with 10 times reduced risk of death at 8 weeks following the resumption of aspirin. For those who were on double antiplatelet agents for indwelling stent in blood vessels, both antiplatelet agents should not be stopped because there is a high risk of stent thrombosis. For those who were under warfarin treatment, fresh frozen plasma (FFP), vitamin K, prothrombin complex concentrates, or recombinant factor VIIa can be given to reverse the effect of warfarin. High doses of vitamin K should be avoided to reduce the time for rewarfarinisation once the stomach<unk>  has stopped. Prothrombin complex concentrates are preferred for severe<unk> . Recombinant factor VIIa is reserved for life-threatening<unk>  because of its high risk of thromboembolism. Direct oral anticoagulants (DOAC) are recommended instead of warfarin as they are more effective in preventing thromboembolism. In case of<unk>  caused by DOAC, activated charcoal within 4 hours is the antidote of choice.
medical cause of Gastrointestinal bleeding
medical cause of Hematochezia
symptom of Vitamin K deficiency
symptom of Ascariasis
medical cause of Peptic ulcer disease
medical cause of Gastritis
symptom of Gallbladder cancer
medical cause of Abdominal pain