A 68-year-old man with a prior complicated peptic ulcer requires long-term naproxen for osteoarthritis. He is H. pylori negative. Which gastroprotective strategy provides the greatest reduction in recurrent ulcer risk?

• A Switch naproxen to enteric-coated aspirin
• B Switch naproxen to a COX-2 selective inhibitor alone
• C Take naproxen only with food and antacids as needed
• D Co-prescribe a proton pump inhibitor with naproxen ✓

Explanation

In a patient with prior complicated ulcer who must continue a nonselective NSAID, co-prescription of a proton pump inhibitor gives the strongest protection against recurrence and bleeding. Enteric coating reduces local irritation but not systemic prostaglandin inhibition, so it does not prevent ulcers. Antacids are ineffective for prevention. A COX-2 inhibitor alone lowers risk but less than nonselective NSAID plus PPI in very high-risk patients.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.