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LEARNING OBJECTIVES

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After completing this case study, the reader should be able to:

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  • List the options for the evaluation and treatment of a patient with symptoms suggestive of peptic ulcer disease (PUD).

  • Identify the desired therapeutic outcomes for patients with PUD.

  • Identify the factors that guide selection of a Helicobacter pylori eradication regimen and improve adherence with the regimen.

  • Compare the efficacy of three- and four-drug H. pylori treatment regimens and regimens lasting 7, 10 and 14 days or provided in sequential order.

  • Create a treatment and monitoring plan for a patient diagnosed with PUD, given patient-specific information.

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PATIENT PRESENTATION

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Chief Complaint

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“My stomach has been hurting really badly for the past month or so. It seems to get worse at night.”

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HPI

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Justine Ward is a 67-year-old woman who presents to her primary care physician with complaints of episodic epigastric pain for the past 6 weeks. Her pain is nonradiating. It is sometimes worse with meals, but sometimes eating helps improve the pain. She has been experiencing occasional nausea, bloating, and heartburn. She denies any change in color or frequency of bowel movements. She does not have a history of PUD or GI bleeding. She mentions that she has been having frequent headaches for the past month and has been taking naproxen sodium one to two times daily.

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PMH

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  • CAD with drug-eluting stent placement × 3 months

  • Hypothyroidism × 22 years

  • Hyperlipidemia × 10 years

  • Lactose intolerance × 47 years

  • Postmenopausal; LMP ~13 years ago

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FH

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Her mother died at the age of 75 from lymphoma. Her father is alive and has a history of glaucoma, prostate cancer, and AMI at age 70. She has five siblings who are alive. All siblings have a history of hypertension and hyperlipidemia.

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SH

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She is married and has raised three children; she is not employed outside the home. She has never smoked and drinks one to two glasses of wine most days of the week.

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Meds

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  • Plavix 75 mg PO daily

  • Lisinopril 5 mg PO daily

  • Metoprolol tartrate 25 mg PO twice daily

  • Aspirin 325 mg PO daily

  • Synthroid 125 mcg PO daily

  • Atorvastatin 80 mg PO daily

  • MVI tablet PO daily

  • Tums 500 mg PO PRN stomach pain

  • Naproxen sodium 220 mg PO PRN headache (one to two times daily for the past month)

  • Lactaid one tablet PO PRN dairy product consumption

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All

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NKDA

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ROS

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Unremarkable except for complaints noted above

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Physical Examination

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Gen
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Slightly overweight woman in moderate distress

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VS
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BP 110/72 left ...

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