Continuing Medical Education (CME)

Peptic Ulcer Disease

Introduction to this self-study CME activity

 

The identification of H. pylori as the primary cause of ulcers changed the approach to managing patients with suspected PUD. This self-study activity presents a cost-effective strategy for testing and eradication of H. pylori in patients with suspected peptic ulcer disease (PUD). The strategy should reduce ulcer recurrence and prevent the overuse of chronic anti-secretory medications in PUD patients. Key aspects of care include:

• Perform H. pylori test on patients with symptoms of uncomplicated PUD
• Select test (office serum test for exposure, stool antigen test for active infection) based on the circumstances of the patient.
• If test is positive, prescribe H. pylori eradication therapy.
• Long-term acid inhibition is inappropriate management in most instances.

This 2005 update of the guideline also addresses the following points:

• Testing for active HP infection (stool antigen or urea breath testing) is more appropriate than serology testing in areas with low prevalence of active HP infection to reduce unnecessary treatment of individuals without active HP infection.
• The stool antigen test has been reported to have a sensitivity and specificity of more than 90% in untreated patients with suspected HP infection
• Serology tests should not be used after a patient has been treated for HP to confirm cure.
• Many patients have persistent symptoms after documented HP cure. If a patient has recurrent symptoms after a course of HP eradication therapy, consultation for further diagnostic evaluation is warranted.

Audience

This self-study activity is appropriate for primary care clinicians and other health care providers treating patients with peptic ulcer disease.

Authors

Team Members
	A. Mark Fendrick, MD General Internal Medicine Randall T. Forsch, MD Family Medicine R. Van Harrison, PhD Medical Education James M. Scheiman, MD Gastroenterology
Author Disclosures
	Team Member Company Relationship A. Mark Fendrick, MD AstraZeneca, Tap Speaker’s bureau   AstraZeneca, Tap, Meridian Diagnostics Consultant Randall T. Forsch, MD (None)   R. Van Harrison, PhD (None) James M. Scheiman, MD AstraZeneca, Pfizer, Merck Grant/research support   AstraZeneca, Merck, Nitromed, McNeil, Novartis, Tap, Pfizer, Prozen, The GI Company Consultant   AstraZeneca, TAP, Wyeth, Boheringer Ingelheim Speaker’s bureau

Other Acknowledgements

UMHS Guidelines Oversight Team: William E. Chavey, MD R. Van Harrison, PhD Connie J. Standiford, MD Literature search services: Taubman Medical Library Production of Internet format and web site maintenance: Ellen Patrick-Dunlavey, MA

CME Accreditation and Credit Designation

The University of Michigan Medical School is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The University of Michigan Medical School designates this educational activity for a maximum of 1 AMA/PRA Category 1 Credits™.  Physicians should only claim credit commensurate with the extent of their participation in the activity.

This CME activity was released in June 2005, with credit available through May 2008. This activity was reviewed for currency of content in April 2008 and availability of credit extended through April 2011.

Method of Participation

1. View the web pages. You may print the self-study text to read off-line.
2. Complete the on-line learning assessment test.  It will be electronically scored and the correct answers returned immediately for your review.
3. Complete the electronic credit request and activity evaluation.  An electronic certificate of participation will be provided immediately.
4. Print the certificate of participation for your personal records.

 

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