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NBME 21 Answers

nbme21/Block 2/Question#13

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


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submitted by kimcharito(3), FA2018 said misoprostol increase production of GASTRIC mucosa and the question said ESOPHAGUS mucosa....maaaay be is that reason

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submitted by hpsbwz(3),

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

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submitted by usmleuser007(97),

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