JAWAHARLAL NEHRU TECHNOLOGICAL UNIVERSITY HYDERABAD Pharm. D IV Year PHARMACOTHERAPEUTICS - III Previous Question Paper (April/May -2023 - R08)

The clinical management of H. pylori infection aims to eradicate the bacteria to promote ulcer healing and prevent recurrence. The standard first-line treatment is a 10 to 14-day triple therapy regimen consisting of a proton pump inhibitor (PPI) (e.g., omeprazole, lansoprazole) twice daily, combined with two antibiotics, typically clarithromycin and either amoxicillin or metronidazole.

In regions with high clarithromycin resistance or for patients with prior macrolide exposure, bismuth-based quadruple therapy is preferred. This includes a PPI, bismuth subsalicylate, metronidazole, and tetracycline. If initial treatment fails, salvage therapy involves sequential or concomitant regimens using different antibiotic classes, such as levofloxacin-based triple therapy. Adherence to the full course is critical to prevent antibiotic resistance, and confirmation of eradication is typically performed via urea breath test or stool antigen test at least four weeks after completing therapy.

Crohn’s disease and ulcerative colitis are the two primary forms of inflammatory bowel disease, differing significantly in their pathology and clinical presentation:

• Anatomical Distribution: Crohn’s disease can affect any part of the gastrointestinal tract from the mouth to the anus, typically in a patchy, 'skip lesion' pattern. Ulcerative colitis is restricted to the colon and rectum, usually presenting as a continuous, diffuse inflammation starting from the rectum.
• Depth of Involvement: Crohn’s disease is transmural, affecting all layers of the bowel wall, which leads to complications like fistulas, strictures, and abscesses. Ulcerative colitis is limited to the mucosal and submucosal layers.
• Clinical Features: Crohn’s disease often presents with abdominal pain, weight loss, and non-bloody diarrhea. Ulcerative colitis is characterized by bloody diarrhea, urgency, and tenesmus.
• Histopathology: Crohn’s disease frequently shows non-caseating granulomas. Ulcerative colitis typically shows crypt abscesses and pseudopolyps without granuloma formation.
• Surgical Outcomes: Surgery in ulcerative colitis (e.g., proctocolectomy) can be curative. Surgery in Crohn’s disease is palliative, aimed at managing complications like obstructions or fistulas, as the disease often recurs at the anastomotic site.