Everyone asking why not PPIs?
if you give NSAIDs which decrease PGs so you get GERD, the simplest way to fix it is to bring those PGs back, so misoprostol.
Just simply -PGs --> +PGs
Prostaglandins increase GI motility due to peristalsis. It's the same reason why the uterus contracts during menstruation.
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My guess for not choosing PPI is because the duration of drug-using. PPI increases the risk of C. diff by long-term using which considered as over 1 year of using. This pt should have used the second drug less than 4 weeks according to the question. So PPI is unlikely to cause C. diff diarrhea within this short period of usage, especially when this pt is not immunocompromised, or using antibiotics.
heyT gteguss otoolipsrsM ot ntuctoacer .NsA.ID.S hyW otn IPsP?
I just realized there were solid arrows and dashed arrows in the image. Is there a significant to the dashed arrows vs the solid arrows?
The first drug given was an NSAID (prostaglandins inhibitor) this caused GERDS/ulcer because of decrease mucosal protection.
The second drug was misoprostol which gives mucosa protection and a common side effect is diarrhea.
IPP escitde-f:sfe + credenisa isrk rof C. ffdi + edrcsnaeI srki rof rsep fitcoisnne + nac asuce oagimypsahen + sdreceea snprotaobi of 2C,+(a M2g+, p;a&m )oinr + redaecisn skir fo ectropsiooot phi rstacrfue /(td wol semur ami)uclc