Family Nurse Practitioner Exam

For an uncomplicated case of Helicobacter pylori negative peptic ulcer disease, what is the initial treatment indicated?

1. Omeprazole (Prilosec)

2. Misoprostol (Cytotec)

3. Ranitidine (Zantac)

4. Pepto-Bismol tablets

The correct answer is: Misoprostol (Cytotec)

In the management of uncomplicated peptic ulcer disease, especially when Helicobacter pylori infection is ruled out, the correct initial treatment focuses on acid suppression and protection of the stomach lining. Misoprostol serves as a prostaglandin E1 analog that helps to protect the gastric mucosa by stimulating mucus and bicarbonate secretion and promoting epithelial cell turnover. This is particularly beneficial in preventing NSAID-induced ulcers, but it can also be employed to manage uncomplicated peptic ulcer disease. While proton pump inhibitors like omeprazole are commonly used to provide effective acid suppression, misoprostol should also be considered in specific cases to enhance gastric protection, particularly in patients at risk of ulcer complications due to long-term NSAID use. Ranitidine, which is an H2 blocker, reduces gastric acid secretion but is not as potent as a proton pump inhibitor, making it less effective in certain cases. Pepto-Bismol provides some mucosal protection and symptomatic relief but is not a first-line treatment for the ulcer itself. Thus, the evidence supports misoprostol as a valuable option for the management of uncomplicated peptic ulcer disease in certain conditions, particularly when gastric protection is a primary concern.