Question

GI Case Study

A 45-year-old store manager complained of a burning, gnawing pain, moderately severe, almost always in the epigastric region. The pain is absent when he awakens, appears in midmorning, and is relieved by food but recurs two to three hours after a meal. The pain often awakens him at 1 or 2 a.m. An endoscopic examination and x-ray studies with barium showed normal stomach function but the presence of duodenal ulcers. Fasting serum gastrin levels were normal. H. pylori testing was negative. Treatments for this individual might include the following:

Antacids: 15-30 mL of liquid or two to four tablets one to three hours after each meal and at bedtime for six weeks.

Histamine (H2) receptor antagonists: cimetidine (300 mg) or ranitidine (150 mg) with each meal and at bedtime for four to eight weeks.

Omeprazole (proton pump inhibitor): 20 mg two times a day.

1. What is the diagnosis of this individual?
2. What is the significance of doing a fasting serum gastrin level?
3. What is the purpose of taking antacids?
4. How do the H2 antagonists act in treating this disorder?
5. How does omeprazole act in treating this disorder?
6. What is H. pylori?
7. Most person who are H. pylori positive do not develop ulcers. What host (patient) factors would increase the risk that colonization with H. pylori would lead to the development of ulcer?
8. How are most patients treated with positive H. pylori testing?
9. How do NSAIDs cause ulcers?

Answer 1

1. The diagnosis of this patient is 'Duodenal Ulcer'. A peptic ulcer which develops in the duodenum is called a Duodenal ulcer.

2. Significance of doing a fasting serum gastrin is to know whether one is producing too much gastrin in their body without the presence of food. Gastrin regulates the stomach acid and helps in digestion. In conditions like peptic ulcer, gastrinoma, zollingers syndrome the gastrin levels are increased even without food. So, fasting levels are considered to check whether the gastrin is only aiding the digestive process or being increased over the range.

3. Antacids help to neutralize the excess acid secreted by the gastrin. Antacids act as alkalies and neutralize the acid levels in the stomach and maintain the pH.

4. H2 receptor antagonists block binding of histamine to its receptors. Histamine activates the parietal cells of the stomach to produce gastric acid. Increased acid production disrupts the stomach lining and causes ulcers. So blocking histamine prevents regulation of acid producing cells.

5. Proton pumps present on the stomach lining help in producing acid for digestion. Omeprazole is a proton pump inhibitor which decreases acid produced, thereby healing the ulcers.

6. H pylori is a bacteria that grows in the digestive tract and overtime produces ulcera by attacking the stomach lining and also causing infection.

7. Additional factors like intake of anti-inflammatory medication, stress, life style, type of h pylori etc., may aggravate the bacteria to damage the stomach mucosa, causing ulcers.

8. Patients with positive h pylori are also treated the same as above, but two or more antibiotics are added in their drug regimen to treat infection.

9. Overuse of NSAIDS can cause Ulcers. NSAIDS usually block cox-I enzyme which disrupts the production of prostaglandins in the stomach. The PGs protect the mucosa, but due to decreased production they lead to Ulcers.