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LEARNING OBJECTIVES

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

  • 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.

PATIENT PRESENTATION

Chief Complaint

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

HPI

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.

PMH

CAD with drug-eluting stent placement × 3 months

Hypothyroidism × 22 years

Hyperlipidemia × 10 years

Lactose intolerance × 47 years

Postmenopausal; LMP ~13 years ago

FH

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.

SH

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.

Meds

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)

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