172.3 🩺 內科專科考前版

172.3.0.1 1⃣ Clarithromycin Resistance — Game Changer

  • WHO global > 15% R; Asia + Europe > 20%; some 30%+
  • Maastricht VI 2022 + ACG 2017: 高 R area NO clari triple
  • 改: bismuth quadruple OR concomitant OR PCAB-based
  • AST 埌 individualize if refractory

172.3.0.2 2⃣ Vonoprazan (PCAB) Revolution

  • Potassium-competitive acid blocker, far stronger + faster acid suppression than PPI
  • Voquezna Dual (vonoprazan + amox × 14d) — alternative in PCN-tolerant
  • Voquezna Triple (vonoprazan + amox + clari) — same indication
  • Cure 80-85% in clari-R, better adherence
  • Japan + Korea routine use
  • 健保 Taiwan ongoing approval

172.3.0.3 3⃣ MALT Lymphoma Workup + Treatment

  • EGD biopsy, IHC for B-cell + Ki-67
  • Stage IE: gastric only → H. pylori eradication first; 70-80% complete regression
  • Stage IIE+: + LN; eradication ± chemotherapy / radiation
  • t(11;18) +: less responsive to eradication alone — earlier chemotherapy
  • Monitor: EGD + biopsy 3-6 mo intervals
  • 5-yr survival 80-90%+ for IE

172.3.0.4 4⃣ Gastric CA Screening (Asia)

  • Japan: EGD screening 40+ q2-3y (national)
  • Korea: EGD or barium 40+ q2y
  • Taiwan: targeted high-risk; family hx, atrophic gastritis monitoring
  • H. pylori eradication ↓ CA incidence ~ 50% (multi-center RCT)

172.3.0.5 5⃣ Family Screening Indications

  • 1st-degree relative with gastric CA → test all 1st-degree
  • Concomitant H. pylori + atrophic gastritis on biopsy → repeat EGD
  • Pediatric: 䞍 routine; symptomatic only

172.3.0.6 6⃣ Pregnancy + H. pylori

  • Avoid eradication during pregnancy (drug safety + low urgency)
  • Postpartum / lactation completion → standard regimen

172.3.0.7 7⃣ NSAID + H. pylori Interaction

  • 兩 risk factor → 加 risk PUD/bleed
  • High-risk NSAID user (CV + GI): eradicate H. pylori + co-prescribe PPI / misoprostol
  • Routine NSAID start → screen H. pylori? Controversial (not党郚 routine; high-risk yes)

172.3.0.8 8⃣ 健保 / Taiwan

  • 健保 H. pylori treatment for PUD / MALT / atrophic gastritis indication
  • UBT 健保 (PUD work-up)
  • Bismuth available
  • 病人 education: 完敎 14d + 䞍芁 PPI 提前停
  • 盧醫垫 hint: 糖尿病 + 胃癌 family hx 病人 — UBT screen even mild dyspepsia