37 year old male with recurrent upper abdominal pain
A 37-year-old executive returns to your office for follow-up of recurrent upper abdominal pain. He initially presented 6 weeks ago, complaining of an increase in frequency and severity of burning epigastric pain, which he has experienced occasionally for more than 2 years. Now the pain occurs three or four times per week, usually when he has an empty stomach, and it often awakens him at night. The pain usually is relieved within minutes by food or over-the-counter antacids but then recurs within 2 to 3 hours. He admitted that stress at work had recently increased and that because of long working hours, he was drinking more caffeine and eating a lot of take-out foods. His medical history and review of systems were otherwise unremarkable, and, other than the antacids, he takes no medications. His physical examination was normal, including stool guaiac that was negative for occult blood.
A 37-year-old executive returns to your office for follow-up of recurrent upper abdominal pain. He initially presented 6 weeks ago, complaining of an increase in frequency and severity of burning epigastric pain, which he has experienced occasionally for more than 2 years. Now the pain occurs three or four times per week, usually when he has an empty stomach, and it often awakens him at night. The pain usually is relieved within minutes by food or over-the-counter antacids but then recurs within 2 to 3 hours. He admitted that stress at work had recently increased and that because of long working hours, he was drinking more caffeine and eating a lot of take-out foods. His medical history and review of systems were otherwise unremarkable, and, other than the antacids, he takes no medications. His physical examination was normal, including stool guaiac that was negative for occult blood.
➤ What is your diagnosis?
➤ What dietary recommendations should you give the patient?
➤ What medication is indicated?
➤ What botanicals are indicated?
➤ What botanicals are contraindicated?
His symptoms resolved completely with the diet changes and daily
use of the medication.
Results of laboratory tests performed at his first visit show no
anemia, but his serum Helicobacter pylori antibody test was positive.
➤ What is your next step?
Summary: A 37-year-old man presents with complaints of chronic and recurrent upper abdominal pain with characteristics suggestive of duodenal ulcer: the pain is burning, occurs when the stomach is empty, and is relieved within minutes by food or antacids. He does not have evidence of gastrointestinal bleeding or anemia. He does not take nonsteroidal anti-inflammatory drugs, which might cause ulcer formation, but he does have serologic evidence of H pylori infection.
ReplyDelete➤ Most likely diagnosis: Peptic ulcer disease (PUD)
➤ What dietary recommendations should you give the patient? Avoid offending foods (spicy, fatty, etc),
➤ What medication is indicated? H2 blocker rantidine or PPI Omeprazole
➤ What botanicals are indicated? Demulcents
➤ What botanicals are contraindicated? Bitters
➤ Next step: Antibiotic therapy for H pylori infection