232 Gastroenterology
OSCE Counselling Cases – Answers OSCE COUNSELLING CASE 8.7 – ‘Can I take aspirin for my heart now that I have an ulcer?’ In a patient who has a good indication for non-steroidal therapy such as coronary disease, transient ischaemic attack (TIA) or inflammatory arthritis, aspirin and/or non-steroidal therapy should be resumed after the ulcer has been treated appropriately, typically with triple therapy. PPI should be co-prescribed with the non-steroidal drugs. Consider alternative of clopidogrel, which may be safer.
OSCE COUNSELLING CASE 8.8 – ‘The tablets for my ulcer were wonderful. Should I continue to take them?’ The short answer to this patient is no. He should be told that the H. pylori infection caused the ulcer. Eradicating infection will mean that the ulcer is unlikely to return. It is important to discontinue PPI therapy because of the problems of atrophic gastritis, achlorhydria and bacterial overgrowth.