CASE LEARNING OBJECTIVES
Recognize the signs and symptoms of peptic ulcer disease (PUD)
Identify the desired therapeutic outcomes for patients with PUD
Identify factors that guide selection of an appropriate Helicobacter pylori eradication regimen
Formulate a monitoring plan for patients with PUD on follow-up
"I'm been very nauseated lately. My stomach burns after I eat anything."
History of Present Illness
Robert Benton is a 51-year-old man who presents to his local hospital's emergency department complaining of feeling dizzy, with nausea (no vomiting), lethargy, and epigastric pain—described as "burning" off and on during the day, but especially after eating. He has recently moved to this area from another state and has yet to establish a primary care provider. He has never experienced the symptoms described before. He rarely saw his prior primary care physician in the past, although he had visited her for increasing left-knee pain that she ascribed to osteoarthritis. The patient does not like to take "artificial" medications and refused any treatment for his osteoarthritis. He denies any melena, frank blood in stool, throwing up blood, chest pain, or any other symptoms. Because of the nausea he has not eaten or drunk much in the last 3 days.
Osteoarthritis of left knee.
"High cholesterol" "diagnosed" at a health fair 1 year ago. He had not told his former primary care physician about this.
His father had a history of HTN and hyperlipidemia, but died of colon cancer at age 72. Mother is alive and well at age 74. He has no siblings.
The patient is married and lives with his second wife. He has one son from a prior marriage, aged 18. He works as a certified public accountant. He is generally uncomfortable with taking medications, and feels that "natural" medicines are preferable to "artificial pills" (his words).
Social drinker; (−) tobacco or illicit drug use
Allergies/Intolerances/Adverse Drug Events
Penicillin (unknown reaction)
A herbal preparation, "some sort of yeast product," for his "high cholesterol"
Nausea and epigastric pain as listed above; (−) changes in bowel habit or change in color/consistency of stool; dizzy and tired × 2 days, as listed above; anorexia, as listed above; (−) tinnitus, vertigo, or infections; (+) left-knee pain, especially when kneeling or first thing in the morning.
Well-appearing white man, with minimal distress