Refractory Nsaid Ulcers

The most common cause of refractory NSAID ulcer is continued NSAID use. A detailed history, repeated questioning, or interviewing family members often provides a clue to surreptitious use of NSAIDs. Serum salicylates levels are helpful to identify surreptitious aspirin users. Patients with unhealed NSAID ulcers should be treated with a prolonged course of high dose PPI (eg, omeprazole 40 mg twice daily) until the ulcer is healed. Based on the authors' experience, combined treatment with high dose PPI and misoprostol is probably best but this has not been studied prospectively. These chronic, difficult to heal, ulcers recur rapidly when NSAIDs or aspirin are restarted. It is unclear whether switching to a COX-2 inhibitor after ulcer healing would reduce the rate of ulcer recurrence. Substitution of a COX-2 for a traditional NSAID is not thought to have an advantage over conventional NSAIDs with regard to ulcer healing. There is experimental evidence in animals that COX-2 inhibitors actually impair gastric ulcer healing, but the affects in humans are unknown. Thus, we do not recommend switching from a conventional NSAID to a COX-2 inhibitor in the management of refractory NSAID ulcer. Cessation of NSAID use is often the only effective measure to promote ulcer healing.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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