Assignment Overview

Part I - GI Ulcer Diseases

• Classical therapy: PPIs, H₂RAs, antacids, cytoprotectants (sucralfate, misoprostol, bismuth), standard H. pylori triple/quadruple regimens
• Recent developments:
  • P-CABs (Vonoprazan) - the biggest pharmacological advance in acid suppression in decades: reversible K⁺-competitive H⁺/K⁺-ATPase inhibition, rapid onset, food-independent, no CYP2C19 variability
  • Vonoprazan-Amoxicillin dual therapy for H. pylori - reduces antibiotic burden
  • ACG 2024 Guideline shift to bismuth quadruple therapy (BQT) as preferred first-line
  • Rifabutin-based salvage therapy for multi-drug resistant H. pylori
  • Vonoprazan proven non-inferior to IV PPI for peptic ulcer bleeding (RCT, Gastroenterology 2024)

Part II - Inflammatory Bowel Diseases

• Classical therapy: 5-ASA, corticosteroids, thiopurines (AZA/6-MP), anti-TNF biologics (infliximab, adalimumab)
• Recent developments:
  • Selective IL-23p19 inhibitors (Risankizumab, Mirikizumab, Guselkumab) - most significant new class; meta-analysis (5,561 patients) shows high-certainty superior remission and safety
  • JAK inhibitors (Upadacitinib, Tofacitinib) - oral small molecules; upadacitinib now approved for both UC and CD
  • S1P receptor modulators (Ozanimod, Etrasimod) - fully oral, new mechanism
  • AGA 2024 Living Guidelines & 2025 AGA evidence synthesis for therapy positioning
  • FMT and gut microbiome-based therapy as emerging approach

References