AFP Clinical Answers

Peptic Ulcers, Blood Lead Levels in Children, Diabetic Kidney Disease, VTE, Endometrial Biopsy


Am Fam Physician. 2019 Dec 15;100(12):740.

Should clinicians screen and treat H. pylori infection before initiating long-term therapy with NSAIDs to reduce the risk of peptic ulcer disease?

Physicians should perform laboratory screening for and eradicate Helicobacter pylori infection before initiating long-term nonsteroidal anti-inflammatory drug (NSAID) therapy in NSAID-naive patients to reduce the risk of peptic ulcer disease. Physicians should screen for and eradicate H. pylori before initiating long-term NSAID therapy in patients with a history of peptic ulcers.

What blood lead levels in children require investigation?

In 2012, the Centers for Disease Control and Prevention recommended investigation and management with a blood lead level of 5 μg per dL (0.24 μmol per L). More than 500,000 U.S. children were estimated to have high blood lead levels by this criterion in 2017. Blood lead levels of 5 μg per dL or less in apparently asymptomatic children are associated with impaired neurocognitive and behavioral development. Chelation therapy is recommended if a child's blood lead levels are greater than 45 μg per dL (2.17 μmol per L).

What are the antihyperglycemic treatment recommendations for diabetic kidney disease?

In adults with diabetes mellitus, metformin should be used as first-line therapy for glucose management because it is associated with A1C reduction, decreased risk of renal failure, and decreased mortality. Glucagon-like peptide-1 receptor agonists or sodium-glucose cotransporter-2 inhibitors should be considered as second-line therapy for patients with diabetic kidney disease to reduce progression of the disease.

What is the preferred anticoagulant for long-term prevention of recurring VTE in patients with cancer?

Compared with vitamin K antagonists, low-molecular-weight heparin reduces recurrent venous thromboembolism (VTE) in patients with cancer (number



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