NBME 21 Answers : Block 2 : #13 = A 53-year-old woman with gastroesophageal reflux ...

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NBME 21 Answers

nbme21/Block 2/Question#13

A 53-year-old woman with gastroesophageal reflux ...

Omeprazole

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submitted by hpsbwz(11),

Omeprazole heals gastric and duodenal ulcers more effectively than misoprostol, whereas misoprostol was more effective in patients with erosions alone.

https://www.nejm.org/doi/full/10.1056/NEJM199803123381105

+2 upvote downvote
submitted by kimcharito(4),

well...in FA2018 said misoprostol increase production of GASTRIC mucosa and the question said ESOPHAGUS mucosa....maaaay be is that reason

champagnesupernova3 Reducing acid production helps mucosa heal alot more than increasing prostaglandins. We learn about misoprostol because it can be used if you dont have anything else but you're never gonna choose it over a PPI +

+0 upvote downvote
submitted by usmleuser007(125),

just a hunch.... Omeprazole is always the right answer

nala_ula Famotidine is an H2 blocker which really only stops acid secretion via the stimulation of H+/K+ ATPase by histamine, but it still has vagus and gastrin stimulation. If you use Omeprazole, you get irreversible inhibition of the pump itself which stops the secretion of acid even if there is histamine, gastrin, vagus stimulation. +3

temmy what about the healing of her mucosa. Is that not the action of prostaglandin?. That threw me off cos according to FA, misoprostol increases secretion of the gastric mucosa +4

cry2mucheveryday same doubt..marked miso +

sahusema I guess because misoprostol is more associated with treatment of NSAID related ulcers and PPIs are 1st line DOC for GERD? +1

+0 upvote downvote
submitted by chandlerbas(1),

pt sx not responsive to dietary changes or stress reduction. stress (cortisol) decreases prostaglandins 327 (roles of cortisol). so were told that shes reduced her stress so logically her cortisol would be less, disinhibiting prostaglandin production. But her Sx still persist? thats why i ruled out misoprosol. also i remember from sketchy that ppis are irreversible tbh im not really sure if my logical flow is right, but like the guy in the other comments said, omeprazole always. just like ACEi and octreotide baby