Nucleos(t)ide analogues (NAs) are essential in the treatment of chronic hepatitis B (CHB) due to their capacity to efficiently limit viral replication.

Nucleos(t)ide analogues (NAs) are essential in the treatment of chronic hepatitis B (CHB) due to their capacity to efficiently limit viral replication. Entecavir, tenofovir disoproxil fumarate (TDF), and tenofovir alafenamide (TAF) are drugs that suppress HBV’s reverse transcription process, lowering viral DNA levels and inflammation, lowering the likelihood of consequences such as cirrhosis and hepatocellular cancer. TAF is generally recommended over TDF for patients with renal impairment or osteoporosis because to its lower systemic effects. Treatment selections are influenced by a variety of factors, including the patient’s HBV genotype, liver disease stage, comorbidities, and risk of medication resistance. While NAs considerably enhance disease management, they do not target covalently closed circular DNA (cccDNA), a type of virus that lives in liver cells and prevents a complete cure. Long-term therapy and thorough monitoring are essential for maintaining viral suppression while reducing side effects and resistance. Advances in NA therapy highlight the significance of customized treatment options to improve patient results.
References
Dhir, V., & et al. (2023). Nucleos(t)ide Analogues for CHB Treatment. Hepatitis B Guidelines Overview. Retrieved

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Managing peptic ulcer disease may require adjustments to patients’ treatment plans over time due to changes in their symptom severity, underlying health conditions, or comorbidities. Discuss the process of evaluating and monitoring patients with peptic ulcer disease to determine the most appropriate treatment plan and when modifications may be necessary.
The process of management of a patient with peptic ulcer disease first starts with a proper evaluation. It is important to identify the etiology of a patient with peptic ulcer disease. Most peptic ulcers are caused either by the use of aspirin/NSAIDs or Helicobacter pylori. Patients with peptic ulcers caused by the use of aspirin/NSAIDs need to initially stop their regimen of aspirin/NSAIDs as the inhibition of COX-1 leads to the decrease of prostaglandins responsible for the protective lining of the stomach. Proton pump inhibitor therapy should be started, such as omeprazole 20 – 40mg daily (4 – 6 weeks for ulcers <1cm, 6 – 8 weeks for ulcers >1cm). Proton pumps irreversibly inhibit the hydrogen/potassium proton pumps in the stomach, suppressing the acidity of the stomach which allows the ulcer to heal more effectively. After this initial therapy of PPI, if the patient continues to have the ulcer, has a ulcer >2cm with other comorbidities/>50 years of age, or has frequent ulcers, maintenance therapy of PPI is continued (UpToDate, 2024)
There are several first line treatment for peptic ulcer disease caused by H. pylori. The current preferred treatment is quadruple therapy (bismuth, metronidazole, tetracycline, and a PPI). Other options include rifabutin triple therapy (rifabutin, amoxicillin, and a PPI) and potassium-competitive acid blocker containing regimen, such as vonoprazan and amoxicillin (UpToDate, 2024). There are several factors to consider, such as macrolide resistance, high local clarithromycin resistance, and penicillin allergies. Some modifications would include not using clarithromycin containing regimen in resistant strains/local resistance or swapping out amoxicillin for metronidazole in clarithromycin triple therapy.

 

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