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Continuing Medical Education Questions: February 2017

Moawad, Fouad J MD, FACG1

American Journal of Gastroenterology: February 2017 - Volume 112 - Issue 2 - p 239
doi: 10.1038/ajg.2016.607
CLINICAL GUIDELINES
Free

1Scripps Green Hospital, La Jolla, CA

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Article Title: ACG Clinical Guideline: Treatment ofHelicobacter pyloriInfection

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Questions:

  1. A 55-year-old man is admitted with an upper gastrointestinal bleeding secondary to a gastric ulcer, which was successfully treated with epinephrine injection and hemostatic clips. Gastric biopsies confirm Helicobacter pylori. He is treated with a 14-day course of amoxicillin, clarithromycin, and proton pump inhibitor (PPI). Fecal antigen testing 4 weeks later performed after discontinuation of PPI is positive for H. pylori. Which one of the following treatment regimens would you recommend next?
    1. Retreatment with amoxicillin, clarithromycin, and PPI with adjuvant probiotics for 14 days
    2. Dual therapy with high-dose amoxicillin and PPI for 7 days
    3. Quadruple therapy with bismuth, metronidazole, tetracycline, and PPI for 14 days
    4. Sequential therapy with amoxicillin and PPI for 5 days followed by clarithromycin, nitroimidazole, and PPI for 5 days
  2. Which one of the following antibiotics has the highest resistance rate?
    1. Metronidazole
    2. Clarithromycin
    3. Amoxicillin
    4. Tetracycline
  3. Which one of the following factors is the single most important predictor of success of treatment for H. pylori?
    1. Antibiotic sensitivity
    2. Low side effect profile of medications
    3. Cigarette smoking
    4. Loss of CYP2C19 function
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