DDSEP Quick Quiz

DDSEP quick quiz July question 1

A 60-year-old woman is admitted to the hospital with an upper GI bleed and found to have a gastric ulcer. Biopsies from the ulcer show no malignancy. Gastric biopsies reveal no Helicobacter pylori and stool antigen for H. pylori is also negative. The patient denies any NSAID use. She is discharged home on twice-daily PPI. Two months later, she returns for a follow-up endoscopy, and the ulcer has healed.

What is your recommendation for this patient?

A. Continue once-daily PPI indefinitely

B. Discontinue PPI

C. Continue once-daily PPI for 2 more months

D. Discontinue PPI and start sucralfate

Q1. Correct Answer: A

Rationale
This patient has an idiopathic, non-NSAID, non-H. pylori-associated ulcer and should be on daily PPI indefinitely. These patients have a high rate of recurrent bleeding (42%) and mortality when followed prospectively without being on antisecretory therapy. Although no randomized trials have assessed the benefit of medical cotherapy in this population, antiulcer therapy seems to reduce recurrent idiopathic ulcers.

References
1. Wong G.L.H., Wong V.W.S. Chan Y., et al. High incidence of mortality and recurrent bleeding in patients with Helicobacter pylori-negative idiopathic bleeding ulcers. Gastroenterology. 2009;137:525-31.
2. Laine L. Jensen D.M. Management of patients with ulcer bleeding. Am J Gastroenterol. 2012;107[3]:345-60.

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