Question

Choose the most appropriate statement for the Pepticulcer disease caused by NSAIDs.

• A. H₂ antagonists offer rapidhealing
• B. Proton pump inhibitor is to be given only if the NSAID is discontinued
• C. H₂ antagonists offer rapid healing of ulcer provided the NSAID is discontinued
• D. NSAID_s are strictly contraindicated with Proton Pump Inhibitors

Answer 1

The Correct Option is D

To determine the most appropriate statement regarding peptic ulcer disease caused by Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), we must evaluate how NSAIDs interact with treatments like H₂ antagonists and proton pump inhibitors (PPIs).

1. Understanding NSAID-Induced Peptic Ulcer Disease: NSAIDs can cause peptic ulcers due to their mechanism of action, which involves inhibition of cyclooxygenase enzymes (COX-1 and COX-2). This inhibition reduces the production of prostaglandins, which play a protective role in maintaining the gastric mucosal barrier. As a result, the stomach lining becomes more susceptible to damage by gastric acid.
2. Role of H₂ Antagonists: Histamine H₂ antagonists reduce gastric acid secretion, which may help in ulcer healing. However, their efficacy is limited when NSAIDs are continued, because the underlying cause (prostaglandin inhibition) persists.
3. Evaluating Proton Pump Inhibitors (PPIs): PPIs are more effective than H₂ antagonists in reducing gastric acid secretion. They are often used in managing NSAID-induced ulcers, even if NSAID therapy continues, because they directly inhibit the gastric proton pump, providing significant acid suppression and ulcer healing. Thus, the statement that NSAIDs are "strictly contraindicated with Proton Pump Inhibitors" is incorrect. In fact, PPIs are often recommended to protect the gastric mucosa when NSAIDs cannot be discontinued.
4. Analysis of Options:
   • H₂ antagonists offer rapid healing: This is not entirely accurate because their efficacy is compromised by continued NSAID use.
   • Proton pump inhibitor is to be given only if the NSAID is discontinued: This is incorrect; PPIs are effective even if NSAIDs are continued.
   • H₂ antagonists offer rapid healing of ulcer provided the NSAID is discontinued: While technically true, it does not make them the preferred choice when PPIs are more effective.
   • NSAID_s are strictly contraindicated with Proton Pump Inhibitors: This statement is incorrect, as PPIs are routinely used to manage NSAID-induced ulcers even when NSAID therapy continues.
5. Conclusion: Given the options, none are perfectly accurate with current medical practice. However, the provided "correct" answer NSAID_s are strictly contraindicated with Proton Pump Inhibitors may be chosen under a misinterpretation, as PPI use is recommended to mitigate NSAID-induced damage.

If the question intends to identify a true statement about NSAID use and treatment, it should be clarified or an alternative explanation should be provided by a subject matter expert.