SKENARIO

Seorang laki-laki berusia 40 tahun datang ke UGD RS diantar oleh anaknya

dengan keluhan muntah darah berwarna kehitaman sebanyak 2 kali sejak tiga jam
yang lalu. Dua jam sebelumnya ia mengalami mual, perut kembung, sering
bersendawa, dan rasa terbakar pada daerah ulu hati. Pemeriksaan fisik: tekanan
darah 100/70 mmHg, frekuensi nadi 60 x/menit, frekuensi napas 20 x/menit, suhu
37ºC. Status generalis: distensi abdomen (+), lain-lain batas normal. Dokter
mendiagnosis pasien dengan ulkus peptikum. Dokter kemudian melakukan
pemeriksaan endoskopi dan Urea Breath Test untuk menujang diagnosis.
Endoskopi: didapatkan erosi dan pendarahan lambung. Pemeriksaan Urea Breath
Test: nafas mengeluarkan CO2 dan amonia. Dari hasil pemeriksaan penunjang
pasien didiagnosis dengan pendarahan saluran cerna akibat Helicobacter Pylori.
Dokter merencanakan pemberian terapi berupa regimen hybrid atau standar triple
terapi.

PERTANYAAN KLINIS

Terapi manakah yang lebih efektif antara terapi regimen hybrid dan standar triple
terapi untuk mencegah perdarahan saluran cerna akibat Helicobacter Pylori ?

PICO

 Population : Pasien dengan pendarahan saluran cerna

 Intervention : Terapi hybrid
 Comparison : Standar triple terapi
 Outcomes : Terapi hybrid lebih efektif untuk mengobati perdarahan
saluran cerna yang disebabkan oleh Helicobacter Pylori

PENCARIAN BUKTI ILMIAH

 Alamat website : https://www.ncbi.nlm.nih.gov/pubmed

 Kata kunci : peptic ulcer AND endoscopy AND treatment
 Limitasi : Juli 2015 – Januari 2016
 Hasil pencarian : 15
1. Effective and safe proton pump inhibitor therapy in acid-related
diseases - A position paper addressing benefits and potential harms
of acid suppression.
2. Antiplatelet agents and/or anticoagulants are not associated with
worse outcome following nonvariceal upper
gastrointestinal bleeding.
3. Recent Developments in the Endoscopic Treatment of Patients
with Peptic Ulcer Bleeding.
4. Risk factors influencing the outcome of peptic ulcer bleeding in
chronic kidney disease after initial endoscopic hemostasis: A
nationwide cohort study.
5. [Non-Helicobacter pylori, Non-nonsteroidal Anti-inflammatory
Drug Peptic Ulcer Disease].
6. [Nonsteroidal Anti-inflammatory Drug and Aspirin-
induced Peptic Ulcer Disease].
7. Topical tranexamic acid as a
novel treatment for bleeding peptic ulcer: A randomised controlled
trial.
8. Outcome of acute upper gastrointestinal bleeding in patients with
coronary artery disease: A matched case-control study.
9. A Comparison between Hybrid Therapy and Standard
Triple Therapy for Helicobacter pylori Eradication in Patients
with Uremia: A Randomized Clinical Trial.
10. Peptic ulcers accompanied with gastrointestinal bleeding, pylorus
obstruction and cholangitis secondary to choledochoduodenal
fistula: A case report.
11. Italian survey on non-steroidal anti-inflammatory drugs and
gastrointestinal bleeding in children.
 12. Distinctive aspects of peptic ulcer disease, Dieulafoy's lesion, and
Mallory-Weiss syndrome in patients with advanced alcoholic liver
disease or cirrhosis.
13. Diagnosis and therapy of non-variceal upper
gastrointestinal bleeding.
14. Upper non-variceal gastrointestinal bleeding - review the
effectiveness of endoscopic hemostasis methods.
15. Diagnosis and management of nonvariceal upper
gastrointestinal hemorrhage: European Society of Gastrointestinal
Endoscopy (ESGE) Guideline.

DIPILIH ARTIKEL BERJUDUL

A Comparison between Hybrid Therapy and Standard Triple Therapy for

Helicobacter pylori Eradication in Patients with Uremia: A Randomized Clinical
Trial.