peptic ulcer disease AND management

ACG clinical guideline Helicobacter pylori treatment 2024 peptic ulcer disease

diagram gastric acid secretion parietal cell proton pump Helicobacter pylori peptic ulcer disease adults

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https://gi.org/journals-publications/ebgi/schoenfeld_sep2024

peptic ulcer disease stomach duodenum endoscopy gastric ulcer diagram

mkdir -p "/tmp/workspace/acid-peptic-disease-ppt/src" "/tmp/workspace/acid-peptic-disease-ppt/output" "/tmp/workspace/acid-peptic-disease-ppt/assets" && python "/tmp/skills/shared/scripts/fetch_images.py" "https://cdn.orris.care/cdss_images/a95222fffd2a46da2de47278321960560ad31f2319598dc79db907e488ad8268.png" "https://cdn.orris.care/cdss_images/53457a702afcf6ee5f9d182dec02654d8207c131df7aae969bc01a8d51056b92.png" > "/tmp/workspace/acid-peptic-disease-ppt/assets/fetched_images.json"

~/acid-peptic-disease-ppt

python - <<'PY' import json,base64,os p='/tmp/workspace/acid-peptic-disease-ppt/assets/fetched_images.json' data=json.load(open(p)) for i,x in enumerate(data): print(i, x.keys(), x.get('error'), len(x.get('base64') or '')) if x.get('base64'): b=x['base64'].split(',',1)[1] if ',' in x['base64'] else x['base64'] open(f'/tmp/workspace/acid-peptic-disease-ppt/assets/img{i}.png','wb').write(base64.b64decode(b)) PY

cat > "/tmp/workspace/acid-peptic-disease-ppt/src/build_presentation.py" <<'PY' from pptx import Presentation from pptx.util import Inches, Pt from pptx.enum.shapes import MSO_SHAPE, MSO_CONNECTOR from pptx.enum.text import PP_ALIGN, MSO_ANCHOR from pptx.dml.color import RGBColor from pptx.enum.dml import MSO_THEME_COLOR from pptx.enum.shapes import MSO_AUTO_SHAPE_TYPE from pptx.enum.text import MSO_AUTO_SIZE from pptx.enum.dml import MSO_LINE_DASH_STYLE from pptx.enum.shapes import MSO_SHAPE from pathlib import Path OUT=Path('/tmp/workspace/acid-peptic-disease-ppt/output/Acid_Peptic_Disease_Adults.pptx') AS=Path('/tmp/workspace/acid-peptic-disease-ppt/assets') prs=Presentation(); prs.slide_width=Inches(13.333); prs.slide_height=Inches(7.5) blank=prs.slide_layouts[6] # palette NAVY=RGBColor(18,47,67); TEAL=RGBColor(0,126,132); AQUA=RGBColor(215,244,242); GOLD=RGBColor(224,156,45); RED=RGBColor(183,59,48); INK=RGBColor(31,46,54); GREY=RGBColor(91,105,112); LIGHT=RGBColor(246,248,249); WHITE=RGBColor(255,255,255); GREEN=RGBColor(43,137,91); PALE=RGBColor(235,241,243) def rect(sl,x,y,w,h,fill=WHITE,line=None,r=MSO_SHAPE.ROUNDED_RECTANGLE): s=sl.shapes.add_shape(r, Inches(x), Inches(y), Inches(w), Inches(h)); s.fill.solid(); s.fill.fore_color.rgb=fill s.line.color.rgb=line if line else fill return s def line(sl,x1,y1,x2,y2,color=TEAL,width=1.5): s=sl.shapes.add_connector(MSO_CONNECTOR.STRAIGHT, Inches(x1), Inches(y1), Inches(x2), Inches(y2)); s.line.color.rgb=color; s.line.width=Pt(width); return s def text(sl,x,y,w,h,txt,size=18,color=INK,bold=False,align=None,margin=.06, font='Aptos', valign=None): tb=sl.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h)); tf=tb.text_frame; tf.clear(); tf.word_wrap=True tf.margin_left=tf.margin_right=Inches(margin); tf.margin_top=tf.margin_bottom=Inches(margin) p=tf.paragraphs[0]; p.text=txt p.font.size=Pt(size); p.font.bold=bold; p.font.name=font; p.font.color.rgb=color if align: p.alignment=align if valign: tf.vertical_anchor=valign return tb def bullet_box(sl,x,y,w,h,items,size=16,fill=WHITE,accent=TEAL): rect(sl,x,y,w,h,fill,RGBColor(220,228,230)) tb=sl.shapes.add_textbox(Inches(x+.18), Inches(y+.12), Inches(w-.34), Inches(h-.2)); tf=tb.text_frame; tf.clear(); tf.word_wrap=True tf.margin_left=tf.margin_right=0; tf.margin_top=0; tf.margin_bottom=0 for i,item in enumerate(items): p=tf.paragraphs[0] if i==0 else tf.add_paragraph(); p.text=item; p.level=0; p.font.name='Aptos'; p.font.size=Pt(size); p.font.color.rgb=INK; p.space_after=Pt(7); p.bullet=True p._p.get_or_add_pPr().insert(0, p._p.get_or_add_pPr()._new_buChar(char='•')) return tb def title(sl,t,sub=None,n=0): rect(sl,0,0,13.333,.58,NAVY,NAVY,MSO_SHAPE.RECTANGLE); rect(sl,.45,.58,1.18,.07,GOLD,GOLD,MSO_SHAPE.RECTANGLE) text(sl,.5,.78,12.1,.48,t,27,NAVY,True) if sub: text(sl,.52,1.25,12,.3,sub,11,GREY) text(sl,12.32,7.12,.55,.18,str(n),9,GREY,False,PP_ALIGN.RIGHT) def footer(sl): text(sl,.5,7.12,8,.18,'Adult Acid Peptic Disease | Educational presentation',9,GREY) def pill(sl,x,y,w,txt,fill=TEAL): rect(sl,x,y,w,.38,fill,fill); text(sl,x+.06,y+.055,w-.12,.22,txt,11,WHITE,True,PP_ALIGN.CENTER) def section(sl,label,desc,n): title(sl,label,desc,n); rect(sl,.55,1.85,12.2,4.3,AQUA,AQUA); text(sl,.9,2.45,11.4,.7,label.upper(),37,NAVY,True,PP_ALIGN.CENTER); text(sl,1.3,3.45,10.7,.65,desc,20,TEAL,False,PP_ALIGN.CENTER); footer(sl) #1 title s=prs.slides.add_slide(blank); rect(s,0,0,13.333,7.5,NAVY,NAVY,MSO_SHAPE.RECTANGLE); rect(s,.65,.82,.16,5.55,GOLD,GOLD,MSO_SHAPE.RECTANGLE) text(s,1.13,1.15,10.8,1.18,'Acid Peptic Disease\nin Adults',39,WHITE,True) text(s,1.16,2.72,9.8,.6,'Prevention • Clinical diagnosis • Examination • Investigation • Differential diagnosis • Non-surgical treatment',18,RGBColor(214,234,236)) # native anatomy illustration rect(s,9.55,1.28,2.35,3.85,RGBColor(239,246,244),RGBColor(239,246,244)) # esophagus stomach duodenum rect(s,10.45,1.52,.48,1.15,RGBColor(247,201,136),RGBColor(247,201,136),MSO_SHAPE.ROUNDED_RECTANGLE) st=rect(s,9.82,2.45,1.75,1.45,RGBColor(247,201,136),RGBColor(206,137,80),MSO_SHAPE.ARC); st.rotation=18 line(s,10.92,2.6,11.38,2.9,RGBColor(206,137,80),3); line(s,11.38,2.9,11.06,3.25,RGBColor(206,137,80),3); line(s,11.06,3.25,11.52,3.6,RGBColor(206,137,80),3) text(s,9.75,4.25,2.0,.45,'Stomach + duodenum',13,WHITE,True,PP_ALIGN.CENTER) pill(s,1.15,5.15,2.25,'Clinical teaching deck',GOLD); text(s,1.18,5.78,9.8,.55,'Scope: adult dyspepsia, gastric and duodenal peptic ulcer disease',15,RGBColor(214,234,236)); text(s,1.18,6.62,8,.28,'Updated with 2024 ACG H. pylori guidance',11,RGBColor(171,210,212)) #2 objectives s=prs.slides.add_slide(blank); title(s,'Learning objectives','A practical, patient-centred approach to adult acid peptic disease',2) objs=['Recognize typical and complicated clinical presentations.','Take a focused history and perform targeted examination.','Choose H. pylori testing, endoscopy, and laboratory tests appropriately.','Separate PUD from reflux, functional dyspepsia, biliary, pancreatic, cardiac, and malignant causes.','Treat H. pylori and NSAID-associated disease without surgery and prevent recurrence.'] for i,o in enumerate(objs): y=1.72+i*.88; rect(s,.75,y,.55,.55,TEAL,TEAL); text(s,.75,y+.11,.55,.26,str(i+1),16,WHITE,True,PP_ALIGN.CENTER); text(s,1.55,y+.02,10.8,.48,o,18,INK) footer(s) #3 definition s=prs.slides.add_slide(blank); title(s,'What is acid peptic disease?','An umbrella term, not a single diagnosis',3) text(s,.65,1.7,12,.36,'Peptic ulcer disease (PUD) is a mucosal break in the stomach or duodenum caused by acid-pepsin injury that extends beyond the muscularis mucosa.',19,NAVY,True) for x,head,body,col in [(0.7,'Gastric ulcer','Often linked to H. pylori or NSAIDs. Biopsy at endoscopy to exclude malignancy.',TEAL),(4.52,'Duodenal ulcer','Classically H. pylori-associated; usually benign but can bleed or perforate.',GOLD),(8.34,'Dyspepsia','Epigastric pain/burning, postprandial fullness, or early satiety. PUD is one cause.',RED)]: rect(s,x,2.45,3.38,2.45,WHITE,RGBColor(218,225,227)); rect(s,x,2.45,3.38,.52,col,col,MSO_SHAPE.ROUNDED_RECTANGLE); text(s,x+.15,2.56,3.05,.22,head,17,WHITE,True); text(s,x+.2,3.18,2.98,1.35,body,16,INK) text(s,.8,5.45,11.7,.33,'Clinical principle: symptoms do not reliably establish an ulcer. Confirm the cause and assess for alarm features or complications.',18,RED,True,PP_ALIGN.CENTER) footer(s) #4 causes balance diagram s=prs.slides.add_slide(blank); title(s,'Pathogenesis: injury exceeds defence','Most adult ulcers are associated with H. pylori and/or NSAID/aspirin exposure',4) # balance line(s,2.1,4.75,11.25,4.75,INK,2); line(s,6.68,4.72,6.68,5.62,INK,2); rect(s,6.3,5.6,.76,.28,INK,INK,MSO_SHAPE.ISOSCELES_TRIANGLE) for x,h,b,c in [(1.0,'Aggressors','H. pylori\nNSAID / aspirin\nAcid-pepsin\nSmoking',RED),(8.0,'Mucosal defences','Mucus-bicarbonate\nProstaglandins\nBlood flow\nEpithelial repair',GREEN)]: rect(s,x,1.85,3.45,2.1,PALE,c); rect(s,x,1.85,3.45,.48,c,c); text(s,x+.12,1.96,3.15,.2,h,16,WHITE,True); text(s,x+.22,2.55,2.9,1.12,b,16,INK) text(s,5.02,3.95,3.35,.45,'Imbalance → inflammation → ulcer',16,NAVY,True,PP_ALIGN.CENTER) pill(s,1.25,5.95,3.5,'H. pylori: chronic active gastritis',TEAL); pill(s,5.0,5.95,3.45,'NSAIDs: ↓ prostaglandins',GOLD); pill(s,8.7,5.95,3.2,'Other: critical illness, rare hypersecretion',RED); footer(s) #5 h pylori diagram image s=prs.slides.add_slide(blank); title(s,'H. pylori and duodenal ulcer mechanism','Why eradication matters',5) s.shapes.add_picture(str(AS/'img0.png'), Inches(.55), Inches(1.7), width=Inches(6.15), height=Inches(4.6)) text(s,7.05,1.75,5.6,.4,'Key sequence',21,NAVY,True) bullet_box(s,7.05,2.25,5.55,3.6,['Antral-predominant H. pylori gastritis reduces somatostatin activity.','Relative hypergastrinemia increases acid output and promotes gastric metaplasia in the duodenum.','H. pylori colonizes the metaplastic mucosa, while acid injury and impaired bicarbonate defence contribute to ulceration.','Acid suppression heals the ulcer; eradication reduces recurrence.'],16,WHITE,TEAL) text(s,.72,6.45,5.95,.32,'Adapted clinical mechanism diagram: Schwartz’s Principles of Surgery, 11e, p. 1146.',10,GREY); footer(s) #6 clinical diagnosis s=prs.slides.add_slide(blank); title(s,'Clinical diagnosis: history first','Symptoms establish risk and urgency, not ulcer location',6) for x,h,items,c in [(0.65,'Typical dyspepsia',['Epigastric burning, gnawing, or pain','Meal-related discomfort or nocturnal pain','Nausea, bloating, early satiety'],TEAL),(4.52,'Ask specifically about',['NSAIDs, aspirin, steroids, anticoagulants, antiplatelets','Prior ulcer / H. pylori therapy / recent antibiotics','Smoking, alcohol, family history of upper-GI cancer'],GOLD),(8.39,'Clues to complications',['Melena, hematemesis, dizziness or syncope','Sudden severe generalized pain','Persistent vomiting, weight loss, progressive early satiety'],RED)]: rect(s,x,1.82,3.65,4.1,WHITE,RGBColor(220,228,230)); rect(s,x,1.82,3.65,.52,c,c); text(s,x+.15,1.95,3.35,.2,h,16,WHITE,True); bullet_box(s,x+.12,2.52,3.4,2.95,items,15,WHITE,c) text(s,.85,6.25,11.7,.35,'Do not label chest/epigastric discomfort “gastric” until acute coronary syndrome has been considered when the clinical setting warrants it.',16,RED,True,PP_ALIGN.CENTER); footer(s) #7 examination s=prs.slides.add_slide(blank); title(s,'Focused examination and bedside triage','Look for hemodynamic compromise, bleeding, peritonitis, obstruction, and alternative diagnoses',7) for x,h,body,c in [(0.75,'Vitals','Pulse, BP, orthostatic change, respiratory rate, temperature, oxygen saturation. Shock may indicate major bleeding or perforation.',RED),(4.55,'Abdominal exam','Inspect for distension/scars; auscultate; palpate for focal epigastric tenderness, guarding, rigidity, rebound, mass, hepatomegaly.',TEAL),(8.35,'Additional signs','Pallor; dehydration; weight/BMI; lymph nodes; rectal exam if suspected bleeding. Evaluate cardiopulmonary findings when pain could be ischemic.',GOLD)]: rect(s,x,1.8,3.35,3.78,WHITE,RGBColor(218,225,227)); rect(s,x,1.8,3.35,.52,c,c); text(s,x+.15,1.94,3.0,.2,h,16,WHITE,True); text(s,x+.2,2.62,2.95,2.2,body,16,INK) rect(s,.9,5.95,11.55,.66,RGBColor(254,238,235),RED); text(s,1.15,6.13,11,.25,'Emergency referral: hemodynamic instability, overt GI bleeding, rigid abdomen/peritonitis, sepsis, severe persistent vomiting, or suspected perforation.',16,RED,True,PP_ALIGN.CENTER); footer(s) #8 differential s=prs.slides.add_slide(blank); title(s,'Differential diagnosis of epigastric pain / dyspepsia','Use symptom pattern, risk factors, examination, and tests to discriminate',8) rows=[('PUD','Epigastric pain; NSAID/aspirin exposure or H. pylori; may have anemia or bleeding'),('GERD','Heartburn/regurgitation; positional or postprandial reflux symptoms'),('Functional dyspepsia','No structural disease on appropriate assessment; chronic symptoms'),('Biliary disease','RUQ/epigastric episodic pain, often post-fatty meal; ultrasound helpful'),('Pancreatitis','Persistent severe pain radiating to back, vomiting; lipase elevated'),('ACS / ischemia','Exertional or atypical epigastric discomfort; ECG/troponin based on risk'),('Cancer','Weight loss, anemia, progressive dysphagia/vomiting, mass; endoscopy/biopsy')] rect(s,.62,1.55,12.08,.45,NAVY,NAVY); text(s,.85,1.66,2,.18,'Condition',14,WHITE,True); text(s,3.15,1.66,8.8,.18,'Discriminating clinical features',14,WHITE,True) for i,(a,b) in enumerate(rows): y=2.0+i*.59; rect(s,.62,y,12.08,.59,WHITE if i%2==0 else PALE,RGBColor(228,233,235),MSO_SHAPE.RECTANGLE); text(s,.84,y+.15,2.1,.2,a,14,NAVY,True); text(s,3.15,y+.11,9.2,.3,b,13,INK) footer(s) #9 diagnostic flow s=prs.slides.add_slide(blank); title(s,'Diagnostic strategy for uninvestigated dyspepsia','Risk stratify before selecting a noninvasive or endoscopic pathway',9) # boxes and arrows steps=[(4.5,1.55,4.25,.62,'Adult with dyspepsia / suspected acid peptic disease',NAVY),(4.5,2.55,4.25,.62,'Unstable, bleeding, peritonitis, or obstruction?',RED),(.75,3.72,3.65,.78,'YES: resuscitate + urgent emergency / GI / surgical pathway',RED),(4.84,3.72,3.65,.78,'NO: assess alarm features, age/risk, medication exposure',TEAL),(8.95,3.72,3.65,.78,'Low risk, no alarms: noninvasive H. pylori test-and-treat ± PPI trial',GREEN),(4.84,5.12,3.65,.78,'Alarm features, higher cancer risk, or persistent symptoms: upper endoscopy',GOLD)] for x,y,w,h,t,c in steps: rect(s,x,y,w,h,WHITE,c); text(s,x+.12,y+.16,w-.24,h-.15,t,15,INK,True,PP_ALIGN.CENTER) line(s,6.63,2.17,6.63,2.55,NAVY); line(s,4.5,3.17,2.58,3.72,RED); line(s,6.63,3.17,6.66,3.72,TEAL); line(s,8.75,3.17,10.77,3.72,GREEN); line(s,6.66,4.5,6.66,5.12,GOLD) text(s,.78,6.23,11.75,.35,'Alarm features include GI bleeding/melena, iron-deficiency anemia, weight loss, persistent vomiting, early satiety, dysphagia/odynophagia, abdominal mass, or relevant family/personal cancer history.',13,RED,True,PP_ALIGN.CENTER); footer(s) #10 tests s=prs.slides.add_slide(blank); title(s,'Investigations','Match the test to the clinical question',10) items=[('H. pylori stool antigen','Preferred active-infection noninvasive test; also usable for test-of-cure.'),('Urea breath test','Highly accurate active-infection test and test-of-cure alternative.'),('Upper endoscopy (EGD)','Best test to visualize ulcer, biopsy gastric ulcers/lesions, assess bleeding, and obtain rapid urease/histology.'),('CBC, urea/creatinine, LFTs','Assess anemia/bleeding, dehydration or other causes. Add group & screen/crossmatch if significant bleeding.'),('Lipase, ECG/troponin, ultrasound/CT','Selective tests for pancreatic, cardiac, biliary, perforation, or alternative disease. Do not order routinely.')] for i,(a,b) in enumerate(items): y=1.58+i*.96; rect(s,.72,y,11.95,.73,WHITE,RGBColor(219,227,229)); pill(s,.88,y+.16,2.5,a,TEAL if i<3 else GOLD); text(s,3.62,y+.14,8.65,.38,b,15,INK) text(s,.85,6.55,11.5,.25,'Medication effect: PPIs, bismuth, and antibiotics can cause false-negative active-infection tests. Plan the timing before testing.',14,RED,True,PP_ALIGN.CENTER); footer(s) #11 endoscopy s=prs.slides.add_slide(blank); title(s,'When endoscopy changes management','Endoscopy confirms pathology and permits biopsy or endoscopic hemostasis when indicated',11) s.shapes.add_picture(str(AS/'img1.png'), Inches(.55), Inches(1.55), width=Inches(6.15), height=Inches(4.6)) bullet_box(s,7.08,1.62,5.45,4.2,['Perform promptly for alarm features, suspected upper-GI bleeding, gastric outlet obstruction, or high concern for malignancy.','A gastric ulcer should be biopsied unless clearly inappropriate, because benign and malignant ulcers can look similar.','Endoscopy can identify high-risk bleeding stigmata and enables hemostatic therapy.','Do not use barium studies or routine EGD when perforation is suspected: prioritize imaging and urgent surgical assessment.'],16,WHITE,TEAL) text(s,.66,6.35,5.9,.32,'Adapted diagnostic pathway: Textbook of Family Medicine, 9e, p. 1125.',10,GREY); footer(s) #12 medical therapy s=prs.slides.add_slide(blank); title(s,'Non-surgical management: treatment pillars','Remove the cause, heal the mucosa, and prevent recurrence',12) for x,num,h,b,c in [(0.68,'1','Stabilize complications','IV access, resuscitation and blood strategy for bleeding; IV PPI after appropriate assessment; urgent endoscopic pathway. Peritonitis/perforation is not routine outpatient PUD.',RED),(3.83,'2','Suppress acid','PPI is first-line for ulcer healing. H2 receptor antagonists are alternatives in selected situations. Sucralfate can be adjunctive.',TEAL),(6.98,'3','Eradicate H. pylori','Treat confirmed infection with guideline-concordant antibiotics plus acid suppression; document eradication.',GOLD),(10.13,'4','Modify ulcerogenic exposure','Stop NSAID/aspirin if possible; reassess the indication. If essential, provide gastroprotection and address risk factors.',GREEN)]: rect(s,x,1.92,2.52,3.68,WHITE,c); rect(s,x+.88,1.63,.76,.62,c,c); text(s,x+.88,1.78,.76,.2,num,17,WHITE,True,PP_ALIGN.CENTER); text(s,x+.18,2.52,2.16,.46,h,16,NAVY,True,PP_ALIGN.CENTER); text(s,x+.2,3.18,2.12,1.8,b,14,INK,False,PP_ALIGN.CENTER) text(s,.8,6.32,11.7,.35,'Do not confuse “non-surgical treatment” with “no escalation”: bleeding, perforation, and obstruction require urgent specialist-directed care.',16,RED,True,PP_ALIGN.CENTER); footer(s) #13 h pylori regimen s=prs.slides.add_slide(blank); title(s,'H. pylori treatment in adults','2024 ACG guidance: use locally appropriate, resistance-aware therapy',13) rect(s,.65,1.5,12.05,.68,RGBColor(231,246,243),TEAL); text(s,.92,1.7,11.5,.22,'Preferred empiric treatment-naïve option in North America: optimized bismuth quadruple therapy for 14 days.',18,NAVY,True,PP_ALIGN.CENTER) # regimen pills for x,h,b in [(0.85,'PPI','twice daily'),(3.15,'Bismuth','four times daily'),(5.45,'Tetracycline','500 mg four times daily'),(8.35,'Metronidazole','500 mg three or four times daily')]: rect(s,x,2.65,2.05,1.25,WHITE,TEAL); text(s,x+.1,2.88,1.85,.22,h,16,TEAL,True,PP_ALIGN.CENTER); text(s,x+.12,3.3,1.8,.22,b,13,INK,False,PP_ALIGN.CENTER) bullet_box(s,.82,4.45,5.7,1.7,['Alternative suggested regimens include rifabutin triple therapy or vonoprazan-amoxicillin dual therapy, depending on availability and patient factors.','Avoid empiric PPI-clarithromycin triple therapy unless clarithromycin susceptibility is proven.'],14,WHITE,GOLD) bullet_box(s,6.8,4.45,5.7,1.7,['Confirm eradication in every treated patient with stool antigen, urea breath test, or biopsy-based testing.','Test at least 4 weeks after antibiotics and after stopping PPI/PCAB for at least 2 weeks. H2 blocker or antacid may bridge symptoms.'],14,WHITE,TEAL) text(s,.85,6.55,11.5,.24,'Regimens must be individualized for allergy, previous antibiotic exposure, local resistance, interactions, pregnancy potential, renal/hepatic disease, and local formulary.',13,RED,True,PP_ALIGN.CENTER); footer(s) #14 NSAID prevention s=prs.slides.add_slide(blank); title(s,'NSAID / aspirin-associated ulcer: treatment and prevention','Assess whether the drug is necessary, then lower GI risk',14) for x,h,body,c in [(0.7,'1. Stop or reduce exposure','Discontinue NSAID when clinically possible. Check over-the-counter products. Reassess aspirin indication with the prescriber.',RED),(4.55,'2. Heal and test','Use a PPI for ulcer healing and test for H. pylori. Treat infection if present.',TEAL),(8.4,'3. If NSAID is unavoidable','Use lowest effective dose and gastroprotection, usually a PPI. Consider COX-2 strategy only after cardiovascular and renal risk assessment; misoprostol is an alternative limited by adverse effects.',GOLD)]: rect(s,x,1.85,3.4,3.48,WHITE,c); rect(s,x,1.85,3.4,.5,c,c); text(s,x+.18,2.0,3.0,.2,h,16,WHITE,True); text(s,x+.2,2.68,2.98,1.95,body,15,INK) rect(s,.9,5.82,11.55,.67,RGBColor(234,245,238),GREEN); text(s,1.1,6.02,11.15,.24,'High GI-risk profiles include previous ulcer or bleeding, older age/frailty, high-dose or multiple NSAIDs, concurrent anticoagulant/antiplatelet/corticosteroid, and H. pylori infection.',15,GREEN,True,PP_ALIGN.CENTER); footer(s) #15 prevention s=prs.slides.add_slide(blank); title(s,'Prevention and patient counselling','Prevent recurrence by addressing causes and adherence',15) for i,(h,b,c) in enumerate([('Medication safety','Avoid self-medicating with NSAIDs/aspirin. Use the lowest necessary dose and discuss gastroprotection.',RED),('H. pylori completion','Complete all prescribed doses. Explain expected harmless effects such as dark stools with bismuth.',TEAL),('Test of cure','Book testing when antibiotics are finished and acid suppressors are held at the correct interval.',GOLD),('Lifestyle','Stop smoking. Limit alcohol if it aggravates symptoms. Food avoidance is individualized, not a substitute for treating H. pylori or NSAID risk.',GREEN)]): y=1.65+i*1.12; rect(s,.78,y,11.8,.85,WHITE,RGBColor(220,228,230)); rect(s,.78,y,.72,.85,c,c); text(s,.92,y+.26,.4,.2,str(i+1),16,WHITE,True,PP_ALIGN.CENTER); text(s,1.75,y+.16,2.4,.24,h,17,NAVY,True); text(s,4.1,y+.15,8.1,.35,b,15,INK) footer(s) #16 complication s=prs.slides.add_slide(blank); title(s,'Complications: recognize and escalate early','A non-surgical deck still needs a safe escalation plan',16) for x,h,signs,act,c in [(0.67,'Bleeding','Hematemesis, coffee-ground vomit, melena, syncope, shock, anemia','Resuscitate, IV PPI as appropriate, CBC/type and screen; urgent endoscopic management.',RED),(4.5,'Perforation','Sudden severe pain, rigid abdomen, rebound, free air, sepsis','Nil by mouth, IV fluids, antibiotics, analgesia, imaging and urgent surgical consultation.',GOLD),(8.33,'Obstruction / penetration','Persistent vomiting, dehydration, metabolic alkalosis, back pain/pancreatitis pattern','Admit if significant; correct fluids/electrolytes, endoscopy/imaging and specialist intervention.',TEAL)]: rect(s,x,1.85,3.4,3.9,WHITE,c); rect(s,x,1.85,3.4,.5,c,c); text(s,x+.16,2.0,3.02,.22,h,16,WHITE,True); text(s,x+.18,2.68,2.98,.72,'Recognize: '+signs,14,INK,True); text(s,x+.18,3.72,2.98,1.35,'Action: '+act,14,INK) text(s,.85,6.32,11.5,.3,'These complications require emergency or specialist care. Do not manage a rigid abdomen or unstable GI bleed as uncomplicated dyspepsia.',16,RED,True,PP_ALIGN.CENTER); footer(s) #17 cases s=prs.slides.add_slide(blank); title(s,'Clinical application: two adult cases','Use the framework, then tailor treatment to the patient',17) for x,h,b,plan,c in [(0.7,'Case 1: uncomplicated dyspepsia','34-year-old with epigastric burning, no alarm features, no NSAID use, normal examination.','Noninvasive H. pylori stool antigen or urea breath test. If positive: treat and confirm eradication. If negative: trial PPI and reassess; investigate persistent symptoms.',TEAL),(6.75,'Case 2: high-risk presentation','70-year-old taking naproxen and apixaban, melena, tachycardia, pallor, epigastric tenderness.','Treat as upper-GI bleeding: resuscitate, labs/type and screen, medication review, urgent endoscopy pathway. Do not use outpatient test-and-treat alone.',RED)]: rect(s,x,1.72,5.83,4.65,WHITE,c); rect(s,x,1.72,5.83,.5,c,c); text(s,x+.2,1.87,5.3,.22,h,17,WHITE,True); text(s,x+.25,2.55,5.2,1.1,b,16,INK); rect(s,x+.22,4.15,5.36,1.8,PALE,PALE); text(s,x+.38,4.35,5.02,1.2,plan,15,NAVY,True) footer(s) #18 takehome s=prs.slides.add_slide(blank); title(s,'Take-home clinical algorithm','A safe and effective approach to adult acid peptic disease',18) items=['Triage first: bleeding, peritonitis, obstruction, or instability need urgent escalation.','For low-risk dyspepsia, use an active H. pylori test-and-treat approach where appropriate; do not rely on symptoms alone.','Use EGD for alarm features, higher-risk patients, persistent symptoms, suspected bleeding, and to biopsy gastric lesions.','Treat causes: eradicate H. pylori, stop NSAIDs when possible, prescribe PPIs for healing/protection, and document eradication.','Prevent recurrence with medication review, risk reduction, adherence support, and follow-up.'] for i,t in enumerate(items): y=1.58+i*.88; rect(s,.82,y,.55,.55,TEAL if i<3 else GOLD,TEAL if i<3 else GOLD); text(s,.82,y+.11,.55,.2,'✓',16,WHITE,True,PP_ALIGN.CENTER); text(s,1.62,y+.06,10.9,.38,t,17,INK) footer(s) #19 refs s=prs.slides.add_slide(blank); title(s,'References and educational-use note','Selected sources used to prepare this deck',19) refs=['Chey WD, et al. ACG Clinical Guideline: Treatment of Helicobacter pylori Infection. Am J Gastroenterol. 2024;119:1730-1753.','Schoenfeld P. ACG Guideline on Treatment of Helicobacter pylori: New Recommendations. American College of Gastroenterology, 2024.','Textbook of Family Medicine, 9e. “Peptic Ulcer Disease,” pp. 1124-1126.','Schwartz’s Principles of Surgery, 11e. “Peptic Ulcer Disease,” pp. 1146, 1153.','2025 systematic review: Sapkota B, et al. Pharmacist-led interventions for management of peptic ulcer disease. PLoS One. PMID: 40132025.'] text(s,.75,1.55,11.7,.4,'This presentation is for education. It does not replace local protocols, medication formularies, or clinical supervision.',16,RED,True) bullet_box(s,.75,2.22,11.8,3.65,refs,15,WHITE,TEAL) text(s,.8,6.32,11.6,.32,'Current evidence check: recent systematic reviews were screened. Recent management evidence does not change the core H. pylori guidance shown here (PMIDs 40132025, 38818853, 38517201).',12,GREY,False,PP_ALIGN.CENTER); footer(s) # add minimal metadata prs.core_properties.title='Acid Peptic Disease in Adults' prs.core_properties.subject='Prevention, diagnosis, differential diagnosis, investigations and non-surgical management' prs.core_properties.author='Orris' prs.save(OUT) print(OUT) PY python "/tmp/workspace/acid-peptic-disease-ppt/src/build_presentation.py"

~/acid-peptic-disease-ppt/src/build_presentation.py

python "/tmp/workspace/acid-peptic-disease-ppt/src/build_presentation.py" && python - <<'PY' from pptx import Presentation p='/tmp/workspace/acid-peptic-disease-ppt/output/Acid_Peptic_Disease_Adults.pptx' prs=Presentation(p) print('slides:',len(prs.slides)) for i,s in enumerate(prs.slides,1): txt=' '.join(sh.text for sh in s.shapes if getattr(sh,'has_text_frame',False) and sh.text.strip()) print(i, len(txt), txt[:70].replace('\n',' | ')) PY

python - <<'PY' from pathlib import Path from pptx import Presentation p=Path('/tmp/workspace/acid-peptic-disease-ppt/output/Acid_Peptic_Disease_Adults.pptx') assert p.exists() and p.stat().st_size>100000 prs=Presentation(str(p)) assert len(prs.slides)==19 pics=sum(1 for s in prs.slides for sh in s.shapes if sh.shape_type==13) print(f'File size: {p.stat().st_size:,} bytes') print(f'Slides: {len(prs.slides)}') print(f'Embedded images: {pics}') print('Validation: PASS') PY

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adult peptic ulcer disease endoscopy clinical image diagnostic algorithm H pylori 2024 guideline