A 35-year-old woman with rheumatoid arthritis presents with acute epigastric pain, nausea, and hematemesis. She began taking ibuprofen 800 mg three times daily 3 weeks ago for joint pain. Vital signs show BP 108/72 mmHg, HR 102 bpm. Upper endoscopy reveals a 1.5 cm antral gastric ulcer with a visible adherent clot and no arterial spurting. Rapid urease testing is negative. H. pylori serology is negative. Which of the following interventions would most directly reduce the risk of ulcer recurrence in this patient?
- A)Continue ibuprofen and initiate famotidine 20 mg twice daily
- B)Discontinue ibuprofen, initiate omeprazole 20 mg daily, and test for H. pylori again in 6 weeks
- C)Discontinue ibuprofen and initiate omeprazole 20 mg twice daily for 8 weeksGABARITO
- D)Switch to intravenous ketorolac for pain control and add sucralfate monotherapy
- E)Continue ibuprofen with concurrent celecoxib to reduce GI side effects
Explicação
This patient has NSAID-induced peptic ulcer disease (negative H. pylori serology excludes infection as the cause). The definitive intervention is NSAID discontinuation combined with PPI therapy. High-dose PPI (omeprazole 20 mg twice daily) is the standard trea... Ver explicação completa e trilha adaptativa →