B) Dysphagia

Explanation: Dysphagia refers to the difficulty swallowing, which can manifest as the sensation that food is stuck behind the breastbone.

C) Proton Pump Inhibitors (PPIs) / H2 antagonists

Explanation: Proton Pump Inhibitors (PPIs) and H2 antagonists are commonly used to treat NSAID-associated ulcers by reducing stomach acid and promoting healing.

B) It may improve cure rates

Explanation: Evidence suggests that extending treatment to 14 days may lead to better cure rates for H. pylori associated ulcers, although this remains a controversial topic among healthcare professionals.

B) No, generally no need

Explanation: Generally, there is no need to retest for eradication of H. pylori if the dyspeptic symptoms have resolved, simplifying the follow-up process for patients.

C) Give a Proton Pump Inhibitor (PPI)

Explanation: If the NSAID cannot be discontinued, it is recommended to give a Proton Pump Inhibitor (PPI) to help manage the ulcer and promote healing.

C) 30 minutes

Explanation: The onset of effect for H2-antagonists, such as ranitidine and famotidine, is approximately 30 minutes, making them relatively quick-acting medications for managing gastric acid-related conditions.

B) Heartburn

Explanation: Heartburn or a burning pain in the chest is commonly exacerbated by bending, stooping, lying down, or eating, particularly 30-60 minutes after meals.

B) Inhibition of COX-1 enzyme

Explanation: NSAIDs damage the gastroduodenal mucosa primarily by suppressing gastric prostaglandin synthesis through the inhibition of the COX-1 enzyme, which is crucial for maintaining mucosal integrity.

C) They appear to be safer for GI bleeding risk

Explanation: COX-2 inhibitors are considered to be safer than conventional NSAIDs for reducing the risk of gastrointestinal bleeding, although they still carry an increased risk compared to placebo.

B) 7 days

Explanation: The standard treatment duration for uncomplicated H. pylori associated ulcers is generally 7 days, which is a common practice in managing these types of ulcers.

C) The spontaneous reflux of gastric contents into the mouth

Explanation: Regurgitation is defined as the spontaneous reflux of sour or bitter gastric contents into the mouth, which is a significant symptom of oesophageal issues.

B) Once a day or twice a day

Explanation: H2-antagonists can be administered daily or twice daily (BD), providing flexibility in treatment regimens for patients.

C) The local resistance rate

Explanation: The optimal duration of treatment for H. pylori is influenced by the local resistance rate, as higher resistance may necessitate longer or more intensive treatment regimens to ensure effectiveness.

A) To prevent any complications

Explanation: A key goal of pharmacotherapy in managing GORD is to prevent any complications that may arise from the condition, ensuring better long-term health outcomes for patients.

C) Hiccups

Explanation: Hiccups are considered a less common symptom in the context of oesophageal issues compared to the other listed symptoms.

B) Prior history of PUD

Explanation: A prior history of Peptic Ulcer Disease (PUD) is a significant risk factor for developing NSAID-associated ulcers, indicating that individuals with a history of ulcers are more susceptible to further damage.

B) Uncomplicated PUD

Explanation: The use of H2 antagonists is limited to uncomplicated peptic ulcer disease (PUD), indicating that they are not recommended for more complex cases.

B) Metoclopramide

Explanation: Metoclopramide is a well-known motility stimulant used in pharmacotherapy to enhance gastrointestinal motility, making it a key medication in this category.

B) Increased risk of ulcers

Explanation: NSAID use is commonly associated with an increased risk of Peptic Ulcer Disease (PUD) as these medications can irritate the stomach lining and contribute to ulcer formation.

C) No further treatment is needed

Explanation: If dyspeptic symptoms have resolved, there is generally no need for further treatment, indicating that the initial therapy was likely effective.

B) Acid suppression agents

Explanation: H2 antagonists are classified as acid suppression agents, specifically designed to inhibit acid secretion in the stomach, making them relevant in the management of peptic ulcer disease (PUD).

B) Back flow of gastric contents into the oesophagus

Explanation: Reflux specifically refers to the back flow of gastric contents into the oesophagus, which is a key concept in understanding conditions like GORD.

B) It reduces their gastro-duodenal sparing effect

Explanation: The potential gastro-duodenal sparing effect of selective COX-2 inhibitors may be diminished by concurrent low-dose aspirin therapy, which is important to consider in treatment plans.

C) 50%

Explanation: About 50% of patients with PUD report improvement in their symptoms after eating, although pain typically recurs 2-4 hours later.

B) Its natural history and manifestations

Explanation: A key learning outcome for GORD is to demonstrate an understanding of its natural history and manifestations, which are essential for effective diagnosis and management.

B) To provide symptomatic relief

Explanation: The primary goal of pharmacotherapy in managing conditions such as Gastro-Oesophageal Reflux Disease (GORD) is to provide symptomatic relief to patients, addressing their discomfort and improving their quality of life.

C) 10 hours

Explanation: H2-antagonists generally have a duration of effect of around 10 hours, which allows for effective management of symptoms throughout the day.

C) To monitor acid levels in the oesophagus

Explanation: Oesophageal pH monitoring is used to assess acid levels in the oesophagus, which helps in diagnosing conditions related to acid reflux and other gastrointestinal issues.

C) Proton Pump Inhibitors (PPIs)

Explanation: Proton Pump Inhibitors (PPIs) are recognized as the first-line agents for acid suppression, effectively managing conditions like peptic ulcers.

B) Biliary tract disease

Explanation: Biliary tract disease can present with symptoms that may mimic those of Peptic Ulcer Disease (PUD), particularly in terms of abdominal pain and discomfort.

B) To eradicate H. pylori

Explanation: A primary goal in managing Peptic Ulcer Disease (PUD) is to advise on the management of H. pylori eradication, as this bacterium is a significant contributor to the development of ulcers.

B) Discontinue the offending drug

Explanation: The first and most important step in treating NSAID-associated ulcers is to discontinue the offending NSAID, as this helps to alleviate the cause of the ulcer.

A) Functional dyspepsia

Explanation: Functional dyspepsia, also known as non-ulcer dyspepsia, is one of the conditions that can present with symptoms similar to those of Peptic Ulcer Disease (PUD), making it important to differentiate between them during diagnosis.

C) They are less effective at reducing meal-stimulated acid secretion

Explanation: H2 antagonists effectively inhibit nocturnal acid secretion but are less effective at reducing acid secretion that occurs after meals, which limits their overall effectiveness in certain situations.

C) 85%

Explanation: Fundoplication provides relief of symptoms and healing of esophagitis in more than 85% of patients, indicating its effectiveness as a surgical intervention.

B) A symptomatic clinical condition or histopathological changes resulting from reflux

Explanation: GORD, or Gastro-Oesophageal Reflux Disease, is defined as a symptomatic clinical condition or histopathological changes that arise due to reflux, highlighting its clinical significance.

B) Prokinetics

Explanation: Motility stimulants are commonly referred to as prokinetics, which indicates their role in enhancing gastrointestinal motility.

B) Lifestyle management

Explanation: Lifestyle management is a crucial aspect of GORD management, which includes dietary changes, weight loss, and avoiding triggers to help alleviate symptoms.

B) Local resistance rate of >15%

Explanation: The use of clarithromycin-based therapy as first-line treatment for H. pylori is primarily dependent on the local resistance rate being greater than 15%. If the resistance rate is lower, clarithromycin can be effectively used.

A) Nausea after eating

Explanation: Nausea after eating is listed as a common symptom associated with oesophageal problems, indicating discomfort related to food intake.

B) Regulating normal cellular processes

Explanation: COX-1 is described as a 'housekeeping' enzyme that regulates normal cellular processes such as gastric cytoprotection, vascular homeostasis, platelet aggregation, and kidney function.

C) Epigastric pain

Explanation: Epigastric pain is reported in 80-90% of PUD cases, making it the most common symptom associated with the condition.

B) Acute pancreatitis

Explanation: Acute pancreatitis is known for causing severe epigastric pain, which can be mistaken for the pain associated with Peptic Ulcer Disease (PUD), highlighting the need for careful evaluation.

B) Coffee

Explanation: Coffee is listed as a food that may precipitate reflux, making it important for individuals to avoid it to manage their symptoms effectively.

B) H. pylori infections

Explanation: It is important to test for H. pylori infections in patients with NSAID-associated ulcers, as a positive result would necessitate starting an eradication protocol to treat the infection.

B) Steroids

Explanation: Co-therapy with steroids is known to enhance the toxicity of NSAIDs, increasing the risk of ulcer formation and gastrointestinal complications.

B) Pantoprazole

Explanation: Pantoprazole is one of the examples of proton pump inhibitors (PPIs) mentioned, which are used to reduce stomach acid production.

C) 8 weeks

Explanation: The typical healing time for gastric ulcers (GU) with H2 antagonists is approximately 8 weeks, which is an important consideration in the management of peptic ulcer disease.

B) Headache

Explanation: Headache is listed as a common adverse effect of proton pump inhibitors, along with gastrointestinal symptoms such as nausea and vomiting.

C) PPI (Proton Pump Inhibitor)

Explanation: It is advised to continue daily PPI after the treatment period to help manage gastric acidity and promote healing of the ulcer.

B) 5%

Explanation: Approximately 5% of patients do not respond to BD PPI or a change in PPI, indicating a subset of patients who may require alternative management strategies.

C) Options for treatment of complicated and uncomplicated reflux disease

Explanation: Evaluating treatment options for both complicated and uncomplicated cases of reflux disease is crucial for effective patient management in GORD.

D) Patient's dietary preferences

Explanation: While local resistance rates, availability of drugs, and optimal duration of treatment are critical considerations for H. pylori treatment, a patient's dietary preferences are not typically a factor in determining treatment protocols.

B) To heal oesophagitis if present

Explanation: Another important goal of pharmacotherapy is to heal oesophagitis, which may be present in patients with conditions like GORD, thereby addressing the underlying inflammation and damage.

B) During states of inflammation

Explanation: COX-2 is usually undetectable in most tissues but its expression increases during states of inflammation, making it a target for anti-inflammatory therapies.

B) Taste alteration

Explanation: Clarithromycin is known to cause taste alteration, along with other side effects such as nausea, vomiting, and abdominal pain, making it important for patients to be aware of these potential reactions.

D) 7 days

Explanation: It is necessary to withhold anti-secretory drugs for 7 days prior to oesophageal pH monitoring to ensure accurate measurement of acid levels.

C) They covalently bind to and deactivate the Na/K ATP-ase enzyme

Explanation: PPIs work by covalently binding to the acid-secreting enzyme Na/K ATP-ase, permanently deactivating it, which leads to reduced acid secretion.

B) Weight loss

Explanation: Weight loss is recommended as a lifestyle change that can help reduce oesophageal acid exposure, along with other behaviors such as smoking cessation and elevating the head of the bed.

A) Gastro-Oesophageal Reflux Disease

Explanation: GORD stands for Gastro-Oesophageal Reflux Disease, a condition characterized by the backward flow of stomach contents into the esophagus, leading to various symptoms.

B) 4-8 weeks

Explanation: PPI therapy is recommended for acute treatment for a duration of 4 to 8 weeks, which is essential for managing troublesome symptoms effectively.

D) Common cold

Explanation: The common cold is primarily a respiratory illness and does not present with gastrointestinal symptoms similar to those of Peptic Ulcer Disease (PUD), unlike the other listed conditions.

D) Bismuth

Explanation: Side effects due to bismuth, H2 receptor antagonists, and proton pump inhibitors are considered rare, making them generally well-tolerated in most patients.

B) 4 weeks

Explanation: For uncomplicated duodenal ulcers, a daily administration of PPIs for 4 weeks is sufficient to achieve a healing rate of greater than 90%.

C) Mild disease

Explanation: Most patients with GORD experience 'mild' disease, indicating that the majority do not suffer from severe symptoms.

B) 20%

Explanation: Approximately 20% of adults report experiencing heartburn symptoms at least weekly, highlighting the prevalence of this symptom in the adult population.

C) Tetracycline

Explanation: Tetracycline is contraindicated for use in pregnant women and young children due to potential adverse effects, including effects on bone and teeth development.

C) 1/3

Explanation: Reflux oesophagitis can occur in up to 1/3 of individuals suffering from GORD, indicating a significant complication associated with the condition.

B) No, not usually

Explanation: In most patients with typical symptoms suggesting uncomplicated reflux disease, a formal diagnosis is not usually required, indicating that clinical symptoms are often sufficient for management.

C) Antacids

Explanation: Antacids are highlighted as the mainstay of treatment for mild intermittent symptoms, providing rapid relief of symptoms, which makes them a primary choice in pharmacotherapy.

B) Raising the head of the bed

Explanation: Raising the head of the bed is a recommended behavior to help manage reflux by reducing acid exposure in the oesophagus.

C) Diarrhea

Explanation: Misoprostol can cause diarrhea in 10-20% of patients, which is an important consideration in its use.

B) Write down triggers for reflux

Explanation: Writing down triggers for reflux can help individuals identify their specific intolerances and habits that may need to change for better management of their symptoms.

B) To provide rapid relief of ulcer symptoms

Explanation: Antacids are used as add-on therapy to anti-secretory agents to provide rapid relief from ulcer symptoms, typically taken multiple times a day.

B) Aluminium hydroxide

Explanation: Aluminium hydroxide is a common example of an antacid used to neutralize stomach acidity and is often combined with magnesium compounds.

B) Management of GORD and PUD

Explanation: The reading list specifically mentions resources related to Gastro-Oesophageal Reflux Disease (GORD) and Peptic Ulcer Disease (PUD), indicating a focus on their management and treatment.

C) Liquid, chewable tablets, and soluble tablets

Explanation: Antacids are available in various dosage forms, including liquid, chewable tablets, and soluble tablets, providing options for different patient preferences.

C) Odynophagia

Explanation: Odynophagia, or painful swallowing, is classified as an 'alarm' symptom that may indicate a more serious condition requiring further evaluation.

C) A subset of patients with specific conditions

Explanation: A subset of patients, including those with H. pylori positive ulcers who haven't responded to treatment, may require daily PPIs or H2 antagonists long-term to prevent ulcer recurrence.

B) 12-18 months

Explanation: GORD is common in infancy but typically resolves by 12 to 18 months of age, indicating a natural progression in many cases.

B) To increase pressure at the lower end of the esophagus

Explanation: Fundoplication involves gathering and suturing the fundus of the stomach around the lower esophageal sphincter (LOS) to increase pressure, thereby reducing reflux.

B) Dull, aching, hunger-like

Explanation: The pain associated with PUD is often described as dull and aching, resembling hunger pangs, which is a characteristic symptom of the condition.

B) Longer duration increases risk

Explanation: The duration of NSAID therapy is a critical factor, as longer use increases the risk of developing ulcers due to cumulative damage to the gastroduodenal mucosa.

C) Renal, cardiovascular, and fluid balance issues

Explanation: In addition to gastrointestinal risks, NSAIDs and COX-2 inhibitors can be associated with other potential problems, including renal, cardiovascular, and fluid balance issues, which should be monitored during treatment.

D) Four times a day

Explanation: Misoprostol is indicated for administration four times a day (QID) to effectively manage ulcer prevention and treatment.

B) Oesophageal muscle contractions

Explanation: Manometry measures the rhythmic contractions of the oesophageal muscles, providing information about the pressure and function of the oesophagus.

C) They reduce blood flow

Explanation: NSAIDs are associated with a reduction in gastric mucosal blood flow, which can impair the healing of the mucosa and contribute to ulcer formation.

C) Ondansetron

Explanation: Ondansetron is an antiemetic used to prevent nausea and vomiting, and it does not function as a motility stimulant, unlike the other options listed.

B) Their ability to reduce GORD symptoms

Explanation: It is unclear if the treatment with motility stimulants leads to a reduction in GORD symptoms, indicating a lack of definitive evidence supporting their efficacy.

C) Rash

Explanation: Rash is categorized as an infrequent adverse effect of proton pump inhibitors, while nausea, diarrhea, abdominal pain, and constipation are more common.

C) Eating citrus fruits

Explanation: Eating citrus fruits is advised against as they may precipitate heartburn, making it an inappropriate practice for managing reflux.

B) Asthma

Explanation: Asthma is listed as an extra-oesophageal symptom of Gastro-Oesophageal Reflux Disease (GORD), indicating that GORD can manifest symptoms beyond the esophagus.

C) Postprandial diarrhea

Explanation: Postprandial diarrhea is a symptom that may suggest the presence of a gastrocolic fistula, indicating an abnormal connection between the stomach and colon.

B) If there is no response with H2 antagonists or PPIs

Explanation: Motility stimulants might be trialed if there is no response to H2 antagonists or proton pump inhibitors (PPIs), indicating their potential role as a secondary option in treatment.

B) Take them before a trigger

Explanation: H2 antagonists can be taken before a known trigger to help prevent symptoms, which is a proactive approach in managing mild intermittent symptoms.

B) It has antibacterial activity against H. pylori

Explanation: Bismuth is noted for its antibacterial activity against H. pylori, making it useful in eradication therapy for peptic ulcers.

B) Symptom diary

Explanation: A symptom diary is used for comparison alongside oesophageal pH monitoring to correlate symptoms with acid levels, aiding in the diagnosis.

A) Gastric/duodenal tuberculosis

Explanation: Gastric or duodenal tuberculosis can present with gastrointestinal symptoms that may resemble those of Peptic Ulcer Disease (PUD), necessitating differential diagnosis.

B) Penetrating ulcer

Explanation: Localized and intense pain radiating to the back that is not relieved by food or antacids is indicative of a penetrating ulcer, suggesting a serious complication.

E) >90%

Explanation: For uncomplicated gastric ulcers, PPIs have been shown to achieve a healing rate of greater than 90% when administered daily for 8 weeks.

B) ECG and exercise stress test

Explanation: For unexplained chest pain, an ECG and exercise stress test are recommended to evaluate heart function and rule out cardiac issues.

B) 10 – 20%

Explanation: The prevalence of GORD in the Western world is estimated to be between 10% and 20%, according to systemic reviews.

B) H. pylori infection

Explanation: H. pylori infection is one of the two major causes of Peptic Ulcer Disease, accounting for 90-95% of cases, making it a significant factor in the development of ulcers.

B) Excessive alcohol consumption

Explanation: Excessive alcohol consumption is one of the common causes of Peptic Ulcer Disease, as it can irritate the stomach lining and increase the risk of ulcer formation.

C) Interstitial nephritis

Explanation: Interstitial nephritis is noted as a rare adverse effect of proton pump inhibitors, highlighting the potential for serious side effects despite their general tolerability.

B) NICE

Explanation: The reading list references the NICE Clinical Guideline 17, which pertains to the management of dyspepsia in adults in primary care in the UK.

B) 5%

Explanation: Less than 5% of ulcers are reported to remain unhealed after 8 weeks of daily proton pump inhibitor (PPI) treatment, indicating that most ulcers respond well to this therapy.

C) Fatigue

Explanation: Fatigue is listed as an infrequent adverse effect, while nausea, vomiting, diarrhea, and constipation are common symptoms associated with proton pump inhibitors.

B) Hoarseness

Explanation: Hoarseness or a change in voice is a symptom associated with GORD, indicating the impact of reflux on the larynx and vocal cords.

C) 50%

Explanation: Up to 50% of patients taking one of the triple therapy regimens report side effects, indicating a significant occurrence of adverse reactions among those undergoing treatment.

B) A reparative process following oesophagitis

Explanation: Barrett’s oesophagus is a condition that arises as a consequence of the reparative process following chronic oesophagitis, where the normal esophageal lining is replaced with a type of tissue that can increase cancer risk.

B) Diarrhea

Explanation: Diarrhea is one of the common adverse effects associated with H2-antagonists, along with headache and dizziness, although they are generally well tolerated.

B) It stimulates gastroduodenal mucus and bicarbonate secretion

Explanation: Misoprostol is a prostaglandin analogue that stimulates the secretion of mucus and bicarbonate, which helps protect the gastric mucosa.

B) Intermittent or continuous acid suppression

Explanation: After fundoplication, about 50% of patients will require intermittent or continuous acid suppression to manage their symptoms effectively.

B) Diarrhea

Explanation: Amoxycillin can cause diarrhea as a side effect, along with the possibility of allergic reactions such as skin rash, which patients should be informed about.

B) 10 - 30%

Explanation: Studies indicate that 10 - 30% of patients experience a recurrence of typical reflux symptoms within 5 to 10 years following the fundoplication procedure.

B) Fecal occult blood test (FOBT)

Explanation: The fecal occult blood test (FOBT) is commonly ordered to check for hidden blood in the stool, which can indicate complications such as bleeding ulcers in patients with PUD.

B) Neutralize the acidity of stomach contents

Explanation: Antacids work by neutralizing the acidity of the stomach contents, which helps alleviate symptoms associated with conditions like dyspepsia.

B) Extent of mucosal damage

Explanation: Grading schemes are utilized during endoscopy to assess the extent of mucosal damage in patients with GORD, helping to determine the severity of the condition.

B) Drowsiness

Explanation: A common side effect of motility stimulants such as metoclopramide is drowsiness, which can affect patients' daily activities and should be monitored.

B) Transient relaxation of the LOS triggered by gastric distention

Explanation: The majority of GORD cases are caused by transient relaxation of the lower oesophageal sphincter, which is often triggered by gastric distention, allowing stomach contents to reflux into the oesophagus.

C) Both are available OTC

Explanation: Both antacids and H2 antagonists are available over-the-counter (OTC), making them accessible options for patients seeking relief from mild intermittent symptoms.

B) To look for oesophagitis or other lesions

Explanation: Endoscopy is performed to investigate the presence of oesophagitis or other lesions that may mimic GORD, helping to identify underlying issues that could affect treatment.

E) Both B and C

Explanation: Both fungal (Candida) and viral (herpes simplex virus) infectious oesophagitis can present with symptoms similar to GORD, necessitating careful evaluation.

B) 1/3 to half of the population

Explanation: Previous studies estimate that about 1/3 to half of the population in Hong Kong is infected with H. pylori, reflecting a significant prevalence in this urban area.

E) Viral infections

Explanation: While smoking and conditions like Zollinger-Ellison syndrome can contribute to PUD, viral infections are not commonly recognized as a primary cause of Peptic Ulcer Disease.

D) 80%

Explanation: The ulcer healing rate for NSAID-associated ulcers is approximately 80% at 8 weeks with appropriate treatment, indicating a high likelihood of recovery with proper management.

B) They may mask symptoms of gastric cancers

Explanation: H2-antagonists may mask symptoms of gastric cancers in patients presenting with alarm symptoms, necessitating caution in their use to ensure proper diagnosis and treatment.

B) They assume heartburn and/or regurgitation are the only indicators

Explanation: The estimates of GORD prevalence are limited because they primarily rely on the assumption that heartburn and regurgitation are the sole indicators of the disease, which may not accurately reflect the true prevalence.

B) They do not impact greatly

Explanation: Mild symptoms of GORD may not significantly affect the quality of life, although chronic disease can lead to more serious impacts.

B) 18.9% to 87.7%

Explanation: The prevalence of H. pylori varies significantly across different regions, with a range from 18.9% to 87.7%, indicating a global health concern that varies by location.

C) 80-90%

Explanation: PPI therapy provides adequate control of symptoms in 80-90% of patients, indicating its effectiveness in managing gastro-oesophageal reflux disease.

B) A condition characterized by sores on the stomach lining

Explanation: Peptic Ulcer Disease (PUD) refers to the formation of sores or ulcers on the lining of the stomach or the first part of the small intestine, which can cause significant discomfort and complications.

B) Surgical intervention

Explanation: In severe cases of GORD that do not respond to lifestyle changes or pharmacotherapy, surgical intervention may be considered to correct the underlying anatomical issues contributing to reflux.

C) Further examination is warranted

Explanation: If symptoms persist after empiric therapeutic treatment, further examination is necessary to investigate the underlying causes and adjust treatment accordingly.

B) 28.6% - 70.3%

Explanation: In South-Eastern Asia, the prevalence of H. pylori ranges from 28.6% to 70.3%, indicating a significant public health issue in that region.

C) Losing weight

Explanation: Losing weight can help manage GORD symptoms as excess weight can put pressure on the abdomen, exacerbating reflux by pushing stomach contents into the esophagus.

B) Prior to endoscopy if severe dysphagia is present

Explanation: A barium swallow may be used prior to endoscopy in cases of severe dysphagia to help identify any strictures that may be present.

C) H. pylori

Explanation: Helicobacter pylori (H. pylori) is a bacterium that is commonly associated with the development of Peptic Ulcer Disease, as it can damage the stomach lining and lead to ulcer formation.

B) Serious GI adverse effects

Explanation: All NSAIDs have the potential to cause serious gastrointestinal (GI) adverse effects, making this a significant concern in their use.

B) Advising on sun protection

Explanation: Tetracycline can induce photosensitivity reactions, so it is important to advise patients on sun protection measures such as using sunscreen and avoiding prolonged sun exposure.

B) Nocturnal pain

Explanation: Approximately two-thirds of patients with PUD report experiencing nocturnal pain, which can disrupt sleep and indicate the severity of the condition.

B) To stimulate gastrointestinal motility

Explanation: Motility stimulants, such as metoclopramide and domperidone, are primarily used to enhance gastrointestinal motility, helping to alleviate symptoms related to slow gastric emptying.

B) Endoscopy with biopsy

Explanation: Endoscopy with biopsy is the primary diagnostic tool used for patients who do not respond to empiric treatment or present with alarm symptoms, allowing for direct visualization and assessment of mucosal damage.

B) Proton pump inhibitors

Explanation: Proton pump inhibitors are commonly used in pharmacotherapy for GORD as they reduce stomach acid production, helping to alleviate symptoms and heal esophageal damage.

D) Africa

Explanation: The highest prevalence of H. pylori is reported in Africa, highlighting regional differences in infection rates.

C) <20%

Explanation: Successful treatment of H. pylori infection results in a recurrence rate of less than 20% for ulcers within 1 to 2 years, indicating effective management of the infection.

D) Chronic kidney disease

Explanation: Chronic kidney disease does not typically present with symptoms similar to GORD, while the other options listed can exhibit overlapping symptoms.

B) Oesophagitis

Explanation: Oesophagitis is a well-known complication of GORD, resulting from the inflammation of the esophagus due to acid reflux, which can lead to further complications if not managed properly.

B) Hiatal hernia

Explanation: Anatomic disruption of the gastroesophageal junction is often associated with a hiatal hernia, which can contribute to the development of GORD by affecting the function of the lower oesophageal sphincter.

B) Dyspepsia

Explanation: Antacids are indicated for the treatment of dyspepsia, which is characterized by discomfort or pain in the upper abdomen.

B) To detect GORD complications

Explanation: One of the purposes of performing an endoscopy in patients with GORD is to detect complications associated with the disease, which can inform treatment decisions.

B) Another diagnosis or cause

Explanation: Refractory oesophagitis may suggest another diagnosis or cause, resistance to PPIs, or patient non-adherence, indicating the need for further evaluation and potential changes in treatment.

C) Smoking

Explanation: Smoking is identified as a lifestyle risk factor that can contribute to the development of Gastro-Oesophageal Reflux Disease (GORD) and Peptic Ulcer Disease (PUD), highlighting the impact of personal habits on these conditions.

C) 85 - 90%

Explanation: H2 antagonists have a healing rate of 85 - 90% for duodenal ulcers (DU), indicating their effectiveness in promoting healing in uncomplicated cases.

B) GORD causing histopathologically demonstrable changes in the oesophageal mucosa

Explanation: Oesophagitis refers to the inflammation of the oesophagus that occurs due to GORD, leading to histopathological changes in the oesophageal mucosa, which is a critical aspect of the disease.

B) Further examination is required

Explanation: If 'alarm' symptoms such as troublesome dysphagia, odynophagia, weight loss, or iron-deficient anemia are present, further examination is necessary to rule out more serious conditions.

B) 10%

Explanation: About 10% of adults report experiencing daily symptoms of heartburn, indicating a more severe level of symptom frequency among a subset of the population.

C) Heartburn

Explanation: Heartburn is a common symptom of reflux disease but is not classified as an 'alarm' symptom, which includes more severe indicators like weight loss and dysphagia.

B) Weak lower esophageal sphincter

Explanation: A weak lower esophageal sphincter is a primary cause of GORD, allowing stomach contents to flow back into the esophagus, leading to reflux symptoms.

C) Oceania

Explanation: Oceania is noted for having the lowest prevalence of H. pylori, contrasting with regions like Africa where prevalence is much higher.

B) Nitrates

Explanation: Nitrates are specifically mentioned as drugs that lower LOS pressure, which can lead to dyspepsia by allowing stomach contents to reflux into the esophagus.

B) Smoking cessation

Explanation: Smoking cessation is often recommended as a lifestyle change for managing GORD, as smoking can exacerbate symptoms and contribute to reflux.

A) Increase frequency to BD

Explanation: For the 10-20% of patients who do not respond to initial PPI therapy, the recommendation is to increase the frequency to twice daily (BD) to improve symptom control.

E) Antihistamines

Explanation: Antihistamines are not listed among the drugs that cause stomach irritation, while NSAIDs, iron, tricyclic antidepressants, and corticosteroids are known to cause such irritation.

B) To reduce stomach acid production

Explanation: The primary goal of pharmacotherapy in GORD management is to reduce stomach acid production, which helps alleviate symptoms and prevent damage to the esophagus.

C) 2008

Explanation: The reading list indicates that the American Gastroenterological Association (AGA) published guidelines on GERD in 2008.

A) Gastro-Oesophageal Reflux Disease

Explanation: GORD stands for Gastro-Oesophageal Reflux Disease, which is a condition characterized by the leakage of stomach contents into the oesophagus.

B) Helicobacter pylori infection & NSAID-associated ulcers

Explanation: The reading list specifies that BNF No 63 addresses Helicobacter pylori infection and NSAID-associated ulcers, which are relevant to the management of Peptic Ulcer Disease.

B) 24 hours

Explanation: Although PPIs have a short serum half-life, they have a duration of action that exceeds 24 hours, allowing for effective acid suppression over a longer period.

B) 7-14 days

Explanation: The treatment for complicated H. pylori associated ulcers is recommended to last for 7 to 14 days, ensuring effective eradication of the bacteria.

C) Enhance gastric emptying

Explanation: Motility stimulants are designed to enhance gastric emptying, which is one of their key pharmacological effects.

B) 2 hours

Explanation: Antacids have a short duration of action, lasting less than 2 hours, which is important for patients to understand when managing their symptoms.

A) Peptic ulcer disease

Explanation: Peptic ulcer disease is one of the conditions that can present with symptoms similar to those of GORD, making it important to differentiate between these diseases during diagnosis.

C) They take 30 minutes for effect but last longer

Explanation: H2 antagonists take about 30 minutes to take effect but provide relief for up to 8 hours, making them a useful option for managing symptoms.

C) It has limited use in GORD

Explanation: The barium swallow has limited use in diagnosing GORD, although it may be employed prior to endoscopy in cases of severe dysphagia to identify a stricture.

B) Trial of BD PPI for 3 months

Explanation: A trial of BD PPI (Proton Pump Inhibitor) for 3 months is recommended to assess if GORD is the causative factor for the extra-oesophageal symptoms.

B) They are a major cause of ulcers

Explanation: NSAID use is identified as one of the two major causes of Peptic Ulcer Disease, contributing significantly to the disruption of gastric mucosal protective mechanisms.

B) Improvement after PPI trial

Explanation: If there is improvement in symptoms after the trial of BD PPI, it suggests that GORD may be the causative factor.

B) Inadequate reflux control

Explanation: The presence of erosive oesophagitis reflects inadequate reflux control and suggests that the patient should respond to a higher PPI dose for better management.

B) 1 week (to 2 weeks)

Explanation: The standard treatment regimens for H. pylori eradication typically last for one week, but can extend to two weeks depending on the specific case and treatment response.

B) Local healthcare situation in Hong Kong

Explanation: The article discusses the local healthcare situation in Hong Kong, highlighting various aspects related to healthcare practices and challenges faced in the region.

B) Selective NSAIDs

Explanation: Selective NSAIDs are generally associated with a lower risk of gastrointestinal complications compared to nonselective agents, highlighting their relative safety.

B) Ketoprofen and piroxicam

Explanation: Among nonselective NSAIDs, ketoprofen and piroxicam are identified as having the highest risk of gastrointestinal complications.

C) Patients with esophagitis may not have heartburn

Explanation: Patients with objective evidence of GORD, such as esophagitis or Barrett's esophagus, do not always experience heartburn, indicating that heartburn is not a definitive symptom of GORD.

B) Chest pain

Explanation: Chest pain is a common symptom of GORD, often described as heartburn, which occurs due to the irritation of the esophagus by stomach acid.

B) Sudden, severe, diffuse abdominal pain

Explanation: Sudden, severe, diffuse abdominal pain is a classic symptom that may indicate perforation, a serious complication that requires immediate medical attention.

B) Establishing a causal relationship is difficult

Explanation: It is often challenging to establish a causal relationship between extra-oesophageal reflux symptoms and GORD, making diagnosis complex.

A) Vomiting

Explanation: Vomiting is a common symptom associated with pyloric outlet obstruction, as the blockage prevents food from passing through the digestive tract.

C) <5%

Explanation: The estimated prevalence of GORD in Asia is reported to be less than 5%, indicating a significant difference compared to the Western world.

B) Domperidone

Explanation: Domperidone is often preferred for patients with Parkinson's disease because it has a lower risk of extrapyramidal side effects compared to metoclopramide.

C) 4 weeks

Explanation: Testing for eradication of H. pylori should occur more than 4 weeks after the completion of antibiotics to ensure accurate results.

A) Not specified

Explanation: The text indicates that the prevalence of GORD in Hong Kong is uncertain or not specified, highlighting a gap in epidemiological data for that region.

B) Haematemesis and malaena

Explanation: The presence of haematemesis (vomiting blood) and malaena (black, tarry stools) indicates gastrointestinal bleeding, which is a serious complication.

B) Antacids

Explanation: Antacids are a common treatment option for GORD, as they neutralize stomach acid and provide relief from heartburn and other reflux symptoms.

A) Achalasia

Explanation: Achalasia is an oesophageal motility disorder that can present with symptoms similar to those of GORD, making it essential to consider during diagnosis.

A) 5-10%

Explanation: Hyper-secretory states, such as Zollinger-Ellison syndrome, account for only 5-10% of Peptic Ulcer Disease cases, indicating that they are less common compared to H. pylori and NSAID use.

D) Fever

Explanation: Fever is not typically associated with GORD symptoms, while chronic laryngitis, sore throat, dental disease, and chronic cough are all relevant symptoms.

A) Antacids

Explanation: Antacids or alginates are often the first-line treatments for managing GORD in children, especially in mild to moderate cases.

C) Metallic taste

Explanation: The most common side effect reported by patients taking metronidazole or clarithromycin is a metallic taste, which can be quite bothersome but is generally not serious.

D) >80%

Explanation: PPI therapy has a healing rate of over 80% for erosive oesophagitis, demonstrating its efficacy in treating this condition.

B) Side effects

Explanation: The use of motility stimulants is limited by their side effects, which can deter healthcare providers from prescribing them.

B) Unsuccessful eradication

Explanation: Recurrence of ulcers usually occurs after unsuccessful eradication of H. pylori, highlighting the importance of effective treatment in preventing ulcer recurrence.

B) Non-cardiac chest pain

Explanation: Non-cardiac chest pain is a symptom that may mimic angina in patients with GORD, highlighting the complexity of diagnosing chest pain in these individuals.

B) Because the fetus gets bigger and puts pressure on the stomach

Explanation: GORD is common in the third trimester as the growing fetus exerts pressure on the stomach, leading to increased symptoms of gastro-oesophageal reflux disease.

B) Hydrogen ion diffusion

Explanation: The diffusion of hydrogen ions into the mucosa leads to cellular acidification and necrosis, which are key processes in the development of oesophagitis associated with GORD.

C) Non-adherence to treatment

Explanation: The most common cause of non-healing ulcers is non-adherence to the prescribed treatment regimen, which can significantly impact the healing process.

C) Perforation of the stomach

Explanation: One of the serious complications of untreated Peptic Ulcer Disease is perforation of the stomach, which can lead to severe internal bleeding and requires immediate medical attention.

E) Healthy diet

Explanation: A healthy diet is not listed as a cause of refractory ulcers. The other options, including NSAID/aspirin use and H. pylori infection, are recognized factors that can contribute to non-healing ulcers.

B) Local health policies and practices

Explanation: The article is expected to cover local health policies and practices, focusing on the healthcare system and its effectiveness in Hong Kong.

B) Crohn’s disease

Explanation: Crohn’s disease is one of the conditions associated with refractory ulcers, as it can lead to complications that affect ulcer healing.

D) Statins

Explanation: Statins are not mentioned as drugs that cause dyspepsia, while tricyclic antidepressants, nitrates, anticholinergics, and NSAIDs are known to contribute to this condition.

B) High consumption of coffee

Explanation: High consumption of coffee is noted as a dietary risk factor that can exacerbate symptoms of GORD and PUD, indicating the influence of certain beverages on digestive health.

C) Asthma

Explanation: Asthma is recognized as an extra-oesophageal manifestation of GORD, indicating that reflux can have effects beyond the esophagus, impacting respiratory health.

C) It increases

Explanation: The advantage of ibuprofen having a lower risk of GI complications is lost when it is used at full doses, indicating that higher doses can lead to increased risks.

B) 2-4 weeks

Explanation: Duodenal ulcers typically heal within 2 to 4 weeks after treatment for H. pylori, although individual healing times may vary.

B) 0.1 - 0.3%

Explanation: The global incidence of the condition is reported to be between 0.1% and 0.3%, indicating a relatively low occurrence based on physician diagnoses.

C) Abdominal pain

Explanation: Abdominal pain is a hallmark symptom of Peptic Ulcer Disease, often described as a burning sensation that can occur when the stomach is empty or at night.

C) It increases with advancing age

Explanation: The incidence of the condition is age-dependent, meaning it tends to increase as individuals get older.

B) 2 weeks

Explanation: Testing for H. pylori eradication should be conducted more than 2 weeks after the completion of PPI to avoid false negatives due to the effects of the medication.

B) Gastric ulcers and duodenal ulcers

Explanation: Peptic ulcers specifically refer to gastric ulcers (in the stomach) and duodenal ulcers (in the duodenum), which are the two main types of ulcers that occur in the gastrointestinal tract.

D) All of the above

Explanation: Antibiotics, antidepressants, and NSAIDs can all potentially cause pill-induced oesophagitis, which may present with symptoms similar to GORD.

B) Refer to a specialist

Explanation: For children who do not respond to initial treatments, referral to a paediatrician or dietician is recommended to explore further management options.

D) Mild reflux symptoms

Explanation: Mild reflux symptoms do not warrant surgical intervention; rather, it is the more severe conditions such as high volume reflux or severe esophagitis that lead to such considerations.

B) Symptoms recur within 3 months

Explanation: If symptoms of oesophagitis recur within 3 months after stopping medication, it indicates the need for continuous therapy to manage the condition effectively.

B) Hepatic failure

Explanation: Aluminum-containing antacids should be avoided in patients with hepatic failure, as constipation can precipitate coma in such cases.

C) It reduces the incidence by 50-75%

Explanation: Misoprostol has been shown to reduce the incidence of NSAID-induced gastric ulcers (GU) and duodenal ulcers (DU) by 50-75%, although it is not preferred due to its dosing frequency and side effects.

B) Colonoscopy

Explanation: Colonoscopy is often ordered at the same time as endoscopy, especially if the Fecal Occult Blood Test (FOBT) is positive, to rule out other gastrointestinal issues.

D) >80%

Explanation: The relapse rate is greater than 80% within three months after discontinuing PPI therapy, indicating a high likelihood of symptom recurrence.

C) Antibiotics

Explanation: Antibiotics are specifically mentioned as drugs that can cause irritation to the stomach, which can lead to dyspepsia.

C) Dietary modifications

Explanation: Lifestyle measures, particularly dietary modifications, can help manage GORD symptoms during pregnancy, providing a non-pharmacological approach to treatment.

C) Form a protective raft over the stomach contents

Explanation: Alginates can be added to antacids to increase the viscosity of stomach contents, forming a viscous gel that acts as a protective raft to prevent reflux and protect the esophagus.

B) Irritation in the oesophagus

Explanation: GORD primarily causes irritation in the oesophagus due to the leakage of stomach contents, which can include food, liquid, or stomach acid.

B) Proton Pump Inhibitors (PPIs)

Explanation: Proton Pump Inhibitors (PPIs) are widely recognized as a common therapeutic intervention for managing GORD, as they effectively reduce stomach acid production and alleviate symptoms.

B) Asthma

Explanation: Asthma is a common respiratory symptom associated with GORD, illustrating how reflux can affect respiratory health.

B) Pharmacists

Explanation: Given the context of the article, it is likely to discuss the role of healthcare professionals, including pharmacists, in managing local health issues.

B) Host and pathogen factors

Explanation: When prescribing treatment, it is important to consider host and pathogen factors, including drug resistance, patient allergies, concomitant medications, and previous treatments received.

C) Liquid formulations

Explanation: Liquid formulations of antacids are faster acting and can be more effective than tablets, providing quicker relief from symptoms.

B) Smoking

Explanation: Smoking can lead to chronic dry mouth, which is a risk factor for GORD, as adequate saliva is important for neutralizing stomach acid and protecting the esophagus.

B) Noncompliance with dietary recommendations

Explanation: While noncompliance with medical therapy is a reason for surgical intervention, noncompliance with dietary recommendations alone does not typically necessitate surgery.

B) Initial and ongoing support

Explanation: Pharmacists offer both initial and ongoing support to patients suffering from dyspepsia, helping them manage their symptoms effectively.

D) <5%

Explanation: Ulcer perforation occurs in less than 5% of PUD cases, but it can lead to severe complications such as peritonitis, making it a critical concern.

B) Breaks or defects in the gastric or duodenal mucosa

Explanation: A peptic ulcer is defined as breaks or defects in the gastric or duodenal mucosa that extend through the muscularis mucosae, indicating damage to the lining of the stomach or the first part of the small intestine.

B) H. pylori infection

Explanation: The incidence of the condition is noted to increase in individuals infected with H. pylori, highlighting the role of this bacterium in the disease's epidemiology.

D) Nausea

Explanation: While heartburn, regurgitation, and dysphagia are common symptoms of oesophagitis, nausea is not typically associated with this condition, making it the correct choice.

C) It has decreased

Explanation: The incidence of the condition has decreased in many countries over the last few decades, indicating a positive trend in public health.

C) Cirrhosis

Explanation: Chronic medical illnesses such as cirrhosis are noted as contributing factors to Peptic Ulcer Disease, highlighting the complexity of ulcer formation in patients with underlying health issues.

C) Administer when symptoms occur or are expected

Explanation: Antacids should be given when symptoms occur or are expected, such as after meals and at bedtime, to effectively manage discomfort.

B) Omeprazole

Explanation: Omeprazole, along with pantoprazole and esomeprazole, is available in both IV and oral formulations, making it versatile for different treatment settings.

C) Increased risk of enteric infections

Explanation: Some epidemiological studies suggest that long-term use of PPIs may be associated with an increased risk of enteric infections, including Clostridium difficile-associated disease.

B) Osteoporosis

Explanation: For patients at risk of osteoporosis who are taking PPIs long-term (more than one year), it is important to consider their daily calcium intake and vitamin D status due to the potential risk of fractures.

B) Through contaminated food or water

Explanation: Helicobacter pylori is primarily spread through contaminated food or water, which is a key factor in its transmission and infection.

B) Potential drug interactions

Explanation: Pharmacists must check for potential drug interactions to ensure the safe and effective use of medications in patients with GORD and PUD.

B) Upper endoscopy

Explanation: Upper endoscopy is the primary method for diagnosing Peptic Ulcer Disease (PUD), allowing direct visualization of the ulcers and potential biopsies if necessary.

C) Peritonitis

Explanation: Ulcer penetration occurs when an ulcer perforates into neighboring structures, such as the pancreas, which can result in peritonitis, a serious abdominal condition.

B) Potency of the refluxate and contact time

Explanation: Oesophageal mucosal damage in GORD is related to the potency of the refluxate and the duration of contact time with the oesophageal lining, which can lead to inflammation and injury.

B) NSAID use and hypersecretory states

Explanation: In patients with recurrent ulcers who are H. pylori negative, it is essential to exclude NSAID use and hypersecretory states as potential causes of ulcer recurrence.

B) Relieve dyspepsia symptoms

Explanation: The primary goal of pharmacological management for H. pylori associated ulcers is to relieve dyspepsia symptoms, promote ulcer healing, and eradicate H. pylori.

B) Antibiotic therapy with acid anti-secretory drugs

Explanation: Treatment typically involves a combination of 2-3 antibiotics along with 1-2 acid anti-secretory drugs to effectively promote healing and eradicate H. pylori.

C) Certain medications

Explanation: Certain medications can lead to delayed gastric emptying, which is a contributing factor in GORD as it can increase the likelihood of reflux occurring due to prolonged retention of gastric contents.

B) <10%

Explanation: Less than 10% of patients stop treatment due to side effects, suggesting that while side effects are common, they are often manageable enough for patients to continue their therapy.

B) Spiral-shaped gram-negative rod

Explanation: Helicobacter pylori is characterized as a spiral-shaped gram-negative rod, which is crucial for its identification and understanding its role in ulcer disease.

C) pH 6.0 - 7.0

Explanation: Helicobacter pylori grows optimally at a pH range of 6.0 to 7.0, which is significant for its survival in the gastric environment.

C) Constipation

Explanation: Aluminum-containing antacids can cause constipation, which is an important adverse effect to consider when recommending their use.

B) Advising on appropriate initiation and alternative options of therapy

Explanation: Pharmacists play a crucial role in advising patients on the initiation and alternative options for therapy in the management of GORD and PUD, ensuring effective treatment plans.

B) It must be dosed QID

Explanation: A significant drawback of Misoprostol is that it must be dosed four times a day (QID), which can be inconvenient for patients, along with a high incidence of side effects, making it less preferred.

B) Hydrolysis of urea by H. pylori

Explanation: Urea breath testing is based on the hydrolysis of urea by H. pylori, which produces CO2 and ammonia, indicating the presence of the bacteria.

B) Conduct a pH study

Explanation: If there is no improvement after the PPI trial, a pH study should be conducted to further investigate the reflux symptoms.

E) Ibuprofen

Explanation: Ibuprofen is not part of the standard treatment regimens for H. pylori eradication. The standard regimens include agents like amoxicillin, clarithromycin, and metronidazole.

B) If GORD is not suspected

Explanation: Patients should be off PPI if GORD is not suspected to determine if they still experience reflux symptoms.

B) Twice daily

Explanation: The standard dose of Proton Pump Inhibitor (PPI) used in H. pylori treatment is administered twice daily, which is crucial for effective acid suppression during the treatment.

B) Always check the latest version

Explanation: The reading list advises that one should always check the latest version of the guidelines, emphasizing the importance of using up-to-date information in clinical practice.

E) Acute gastritis

Explanation: Acute gastritis is not a term used to refer to GORD. The other options—indigestion, dyspepsia, reflux, and chronic heartburn—are all associated with GORD.

B) PPI + Bismuth subsalicylate + Metronidazole + Tetracycline

Explanation: For patients who have failed one course of H. pylori treatment, a more intensive regimen is recommended, which includes a PPI, bismuth subsalicylate, metronidazole, and tetracycline.

B) Hormonal changes

Explanation: Hormonal changes during pregnancy are recognized as a risk factor for GORD and PUD, as they can affect the digestive system and increase the likelihood of reflux symptoms.

B) Clarithromycin

Explanation: Clarithromycin is one of the antibiotics associated with potential drug resistance in the treatment of H. pylori, which can affect the success of eradication efforts.

B) Use the lowest effective dose for the shortest time

Explanation: To prevent NSAID-associated ulcers, it is recommended to use the lowest effective dose for the shortest duration necessary, minimizing the risk of ulcer development.

C) Accumulation of magnesium and aluminum

Explanation: In patients with renal failure, magnesium and aluminum can accumulate, leading to potential toxicity, making it crucial to monitor their use.

C) Dietary modifications and smoking cessation

Explanation: Pharmacists provide lifestyle advice, including dietary modifications and smoking cessation, which are important for managing GORD and PUD effectively.

B) By initiating gastritis

Explanation: Untreated H. pylori infection can lead to gastritis, which may initiate a pathogenic sequence of events that can result in gastric cancer if not treated, emphasizing the importance of addressing H. pylori infections.

A) Calcium channel blockers

Explanation: Calcium channel blockers are included in the list of drugs that lower LOS pressure, contributing to the risk of dyspepsia.

B) Idiopathic ulcer

Explanation: An idiopathic ulcer is characterized by being H. pylori negative and not associated with NSAID use, indicating that its cause is unknown.

C) Reduced H. pylori infection rates

Explanation: The decrease in incidence is attributed to reduced rates of H. pylori infection, which has been linked to lower occurrences of the condition.

C) Weight loss

Explanation: Weight loss is often recommended as a lifestyle modification for patients with GORD, as excess weight can increase abdominal pressure and exacerbate reflux symptoms.

D) Food, liquid, or stomach acid

Explanation: In GORD, the contents that can leak back into the oesophagus include food, liquid, or stomach acid, leading to irritation and various symptoms.

C) Reduce the medication dose

Explanation: A common strategy in maintenance therapy for oesophagitis is to reduce the medication dose or use a less potent agent to manage symptoms effectively while minimizing side effects.

B) By the rapidity of recurrence after a trial off medication

Explanation: The need for continued maintenance therapy is assessed based on how quickly symptoms recur after a trial period without medication, guiding further treatment decisions.

C) To relieve symptoms and prevent complications

Explanation: The primary goal of therapeutic interventions for GORD is to relieve symptoms such as heartburn and regurgitation, while also preventing potential complications associated with the disease.

B) History of ulcer disease

Explanation: A history of ulcer disease is one of the multiple risk factors that increase the likelihood of developing NSAID-associated ulcers, necessitating careful consideration before prescribing.

C) They may interact with medications for heart failure

Explanation: Antacids can have drug interactions with concurrent medications, particularly those used in heart failure, necessitating careful monitoring.

A) Gastrointestinal haemorrhage

Explanation: Gastrointestinal haemorrhage is a significant complication of PUD, accounting for 50% of all haemorrhages secondary to this condition, highlighting its serious nature.

C) Decreased oesophageal acid clearance

Explanation: Impaired salivation can lead to decreased oesophageal acid clearance, which may exacerbate the symptoms and damage associated with GORD by allowing acid to remain in contact with the oesophagus for longer periods.

B) Resistance to PPIs

Explanation: Resistance to PPIs is one of the potential reasons for a patient's unresponsiveness to treatment, highlighting the complexity of managing GORD in certain individuals.

B) They have similar efficacy and adverse effects

Explanation: All PPIs are noted to have similar efficacy and adverse effects, although they may vary in their potential to cause drug interactions.

C) It inhibits healing

Explanation: H. pylori infection is known to inhibit ulcer healing, making it a significant factor in the management of peptic ulcer disease.

C) 4-6 times a day or more

Explanation: Antacids can be taken 4-6 times a day or more, but caution is advised regarding excessive use and potential alarming symptoms.

B) Oesophageal cancer

Explanation: One of the potential complications of untreated GORD is the increased risk of oesophageal cancer due to chronic irritation and damage to the oesophageal lining.

B) Benign stricture

Explanation: A benign stricture is a structural issue that may necessitate surgical intervention, especially if it leads to significant symptoms or complications.

D) 90%

Explanation: Helicobacter pylori is present in approximately 90% of patients with duodenal ulcers, indicating a strong association between the bacterium and this type of ulcer.

B) Fluid retention

Explanation: Antacids with high sodium content can lead to fluid retention, so they should be avoided in patients at risk for this condition.

B) Metronidazole

Explanation: For patients who are allergic to penicillin, the standard treatment regimen substitutes amoxicillin with metronidazole, along with clarithromycin and a PPI.

C) They block histamine receptors to reduce acid secretion

Explanation: H2 receptor antagonists are used in the management of GORD as they block histamine receptors in the stomach, leading to a reduction in acid secretion and helping to alleviate symptoms.

E) Chemotherapy

Explanation: Chemotherapy is not a therapeutic intervention for GORD; it is used to treat cancer. The other options, including dietary changes, surgery, and PPIs, are relevant to the management of GORD.

B) In the mucous layer near the epithelial surface

Explanation: Helicobacter pylori is located in the mucous layer near the epithelial surface, where the physiological pH is present, allowing it to thrive.

B) Decreased serum vitamin B12 concentration

Explanation: Long-term use of PPIs has been associated with decreased serum vitamin B12 concentration, which can lead to deficiencies if not monitored.

B) Improving patients’ adherence to therapy

Explanation: Pharmacists are responsible for improving patients' adherence to their treatment regimens, which is vital for the effective management of GORD and PUD.

B) Repeat endoscopy after 12 weeks

Explanation: If there are suspicions of malignancy in a gastric ulcer, a repeat endoscopy is recommended after 12 weeks to document complete healing.

C) 75 - 90%

Explanation: Successful eradication of H. pylori with appropriate pharmacological management is achieved in 75 - 90% of cases, indicating the effectiveness of the treatment.

B) Hiatus hernia

Explanation: Hiatus hernia is identified as a risk factor for GORD, as it can contribute to the weakening of the lower esophageal sphincter, leading to increased reflux symptoms.

B) Peripheral neuropathy

Explanation: Metronidazole can cause peripheral neuropathy as well as CNS toxicity, including seizures, making it important for patients to be aware of these potential side effects.

B) To reduce the risk of NSAID-associated ulcers

Explanation: Administering NSAIDs with a daily proton pump inhibitor (PPI) helps reduce the risk of NSAID-associated ulcers, providing a protective effect on the gastrointestinal lining.

B) When recognizing alarming symptoms

Explanation: Pharmacists are trained to recognize alarming symptoms in patients and should refer them to a doctor when appropriate to ensure proper medical care.

B) Gastric outlet obstruction

Explanation: Gastric outlet obstruction is a complication of PUD that can hinder the passage of food from the stomach to the intestines, leading to significant digestive issues.

B) Preventive healthcare measures

Explanation: The article is likely to emphasize preventive healthcare measures as a crucial aspect of improving the overall health situation in Hong Kong.

B) Large hiatus hernia and persistent regurgitation despite PPI treatment

Explanation: A large hiatus hernia that continues to cause regurgitation despite treatment with proton pump inhibitors (PPIs) is a significant reason for considering surgical intervention.

B) They advise on H. pylori eradication regimens

Explanation: Pharmacists provide guidance on appropriate regimens for the eradication of H. pylori, which is essential in the management of peptic ulcer disease.

B) Oesophagitis has a propensity to relapse

Explanation: Maintenance therapy is often necessary because oesophagitis tends to relapse, requiring ongoing management to prevent recurrence of symptoms.

C) Diclofenac and ibuprofen

Explanation: Diclofenac and ibuprofen are noted to have the lowest risk of gastrointestinal complications among nonselective NSAIDs, although this advantage may diminish at full doses of ibuprofen.

B) If there is failed optimal medical management

Explanation: Surgical intervention is typically considered when there has been a failure of optimal medical management, indicating that other treatment options have not been effective.

C) Insufficient healthcare funding

Explanation: The article may address challenges such as insufficient healthcare funding, which can impact the quality and accessibility of healthcare services in Hong Kong.

B) Disulfiram-like reaction

Explanation: Metronidazole can cause a disulfiram-like reaction when taken with alcohol, which can lead to severe discomfort and should be avoided during treatment and for 24 hours after finishing the course.

C) Repeated course of acute treatment as necessary

Explanation: If a patient experiences remission lasting more than 3 months, the recommended approach is to administer a repeated course of acute treatment as necessary, rather than continuous therapy.

B) 10%

Explanation: Only about 10% of people infected with Helicobacter pylori will develop ulcer disease, highlighting that not all infections lead to clinical manifestations.

B) 3 - 5%

Explanation: For gastric ulcers, 3 - 5% of benign appearing ulcers are found to be malignant, which is why a biopsy is always taken.