This Page Intentionally Left Blank - Int Medical

220 Gastritis and peptic ulcer disease
Pregnancy:
n H2-receptor antagonist (e.g. ranitidine 150 mg PO BID) and sucralfate (1 g
PO QID) are recommended since they are both pregnancy Category B
n antacids taken with time spacing from prenatal vitamins and iron (e.g.
aluminum/magnesium salts, 2–4 teaspoons or 2–4 tablets PO, between
meals and HS)
Special cases:
n patients requiring on-demand relief for occasional pain: pantoprazole 20 mg
PO QD
n patients on chronic therapy (e.g. a PPI) with intermittent need for breakthrough
pain: bismuth salts or antacids (e.g. aluminum/magnesium salts,
2–4 teaspoons or 2–4 tablets PO, between meals and HS)
n elderly patients or others with noncharacterized dyspepsia: a trial of cisapride
(10 mg PO BID) is reasonable and can be added to existing therapy
with PPIs or H2-receptor antagonists
n breastfeeding patients requiring systemic therapy: ranitidine 150 mg PO BID
n functional dyspepsia: PPIs as first line; H2-receptor antagonists (e.g. ranitidine
150 mg PO BID) or, if symptoms are not ulcer-like, sucralfate (1 g PO
QID) as second line
n H. pylori eradication regimen (7-day course): pantoprazole (40 mg PO BID),
clarithromycin (500 mg PO BID), and metronidazole (500 mg PO BID)
References
1. Moayyedi P, Talley NJ, Fennerty MB, et al. Can the clinical history distinguish
between organic and functional dyspepsia? JAMA. 2006;295(13):1566–1576.
2. Servi RJ, Skiendzielewski JJ. Relief of myocardial ischemia pain with a gastrointestinal
cocktail. Am J Emerg Med. 1985;3(3):208–209.
3. Diercks DB, Boghos E, Guzman H, et al. Changes in the numeric descriptive
scale for pain after sublingual nitroglycerin do not predict cardiac etiology of
chest pain. Ann Emerg Med. 2005;45(6):581–585.
4. Dickinson MW. The “GI cocktail” in the evaluation of chest pain in the emergency
department. J Emerg Med. 1996;14(2):245–246.