“I have recurrent H. Pylori infection”. M.C. a 46-year-old Hispanic female presents to the GI clinic for complaint of recurrent H. Pylori infection. She was treated about 2 ½ months ago with H. Pylori triple therapy and failed treatment. She has PMH of dyspepsia, and GERD. She also indicates that she has noticed that her symptoms of dyspepsia are worsening for past 2 months. She has associated her symptoms with nausea, upset stomach with all foods. Denies associated symptoms of hematochezia, melena, hemoptysis, abdominal pain, fever, chills, pain or any other symptoms. Diabetes Mellitus, type 2 High school graduate, married and no children. He frequently eats out in restaurants. He drinks one 4-ounce glass of red wine daily. He is a former smoker that stopped 3 years ago. Both parents are alive. Father has history of DM type 2, Tinea Pedis. Mother alive and has history of atopic dermatitis, tinea corporis and tinea pedis. Constitutional: Negative for fever. Negative for chills. Respiratory: No Shortness of breath. No Orthopnea. Cardiovascular: No edema. No palpitations. Gastrointestinal: No vomiting. +Dyspepsia. + Nausea. No constipation. No melena. No abdominal pain. Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 110/70 T 98.0 po P 80 R 22, non-labored : No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses. :: Hgb 15.2, Hct 40%, K+ 4.0, Na+137, Serum Creatinine normal 1.0, AST/ALT normal. TSH 3.7 normal, glucose 98 normal Pt had EGD done 2 weeks ago that showed H. Pylori positive gastritis in biopsy results. Urea breath test 8 weeks after treatment with H. Pylori medications. Pt needs to stop PPI’s 2 weeks prior to Urea Breath test. No new labs are needed. : may refer based on effect of medication therapy given for 2 weeks. return to office in 8 weeks to reevaluate symptoms. http://gi.org/wp-content/uploads/2017/02/ACGManagementofHpyloriGuideline2017.pdf

H. pylori infection is a common gastrointestinal infection that can cause various symptoms and complications. In the case of M.C., a 46-year-old Hispanic female, she presents to the GI clinic with recurrent H. pylori infection. She had been treated with H. pylori triple therapy about 2 ½ months ago but failed to respond to the treatment.

M.C. also reports worsening symptoms of dyspepsia for the past 2 months. Dyspepsia is a term used to describe a variety of symptoms related to the upper digestive tract, including pain or discomfort in the upper abdomen, bloating, and nausea. Furthermore, M.C. experiences upset stomach with all foods, indicating that her symptoms are not specific to certain types of food.

It is important to note that M.C. denies any associated symptoms of hematochezia (blood in the stools), melena (black, tarry stools), hemoptysis (coughing up blood), abdominal pain, fever, chills, or any other symptoms. This information is vital for ruling out other possible causes of her symptoms and focusing on the H. pylori infection as the primary etiology.

M.C. has a past medical history of dyspepsia and gastroesophageal reflux disease (GERD). These conditions may contribute to her ongoing symptoms and should be taken into consideration when managing her recurrent H. pylori infection.

In terms of her demographic and lifestyle factors, M.C. is a 46-year-old Hispanic female who has graduated from high school and is married with no children. She frequently eats out in restaurants and drinks one 4-ounce glass of red wine daily. She is a former smoker who quit three years ago.

Family history also plays a role in M.C.’s medical background. Her father has a history of type 2 diabetes mellitus (DM) and Tinea Pedis (fungal infection of the foot), while her mother has a history of atopic dermatitis, tinea corporis (ringworm), and tinea pedis. These familial predispositions may provide insights into potential risk factors for M.C.’s recurrent H. pylori infection and help guide further investigations and management.

Upon physical examination, M.C. does not exhibit any constitutional symptoms such as fever or chills. Additionally, her respiratory system is unaffected, showing no signs of shortness of breath or orthopnea. In terms of cardiovascular health, M.C. does not have edema or palpitations.

The focus of the examination then shifts to the gastrointestinal system. M.C. does not report any vomiting, but she does have dyspepsia and nausea. She denies constipation and melena. An assessment of her anthropometric measurements reveals a height of 5 feet 5 inches and a weight of 140 pounds, resulting in a body mass index (BMI) of 31, indicating obesity. Her blood pressure is 110/70, and her temperature is normal at 98.0°F.

Further examination of her abdomen shows no signs of distention or tenderness. Bowel sounds are present in all four quadrants, indicating normal gastrointestinal motility. There is no organomegaly or palpable masses, and the abdomen has a normal contour. Laboratory results are within normal limits, with a hemoglobin (Hgb) level of 15.2 and a hematocrit (Hct) level of 40%. Other measures such as potassium (K+), sodium (Na+), serum creatinine, aspartate aminotransferase (AST), alanine aminotransferase (ALT), thyroid-stimulating hormone (TSH), and glucose are all within normal ranges.

Given the presentation and findings, further investigations are warranted. M.C. had an esophagogastroduodenoscopy (EGD) performed two weeks ago, which revealed H. pylori positive gastritis on biopsy results. To confirm the presence of active infection and assess treatment response, a urea breath test is planned. It is crucial that M.C. stops proton pump inhibitors (PPIs) two weeks prior to the test. No additional laboratory tests are required at this time.

Based on the current management guidelines for H. pylori infection, it is recommended that M.C. return to the office in eight weeks to reevaluate her symptoms. This timeframe will allow for the assessment of treatment response and any necessary adjustments to the therapeutic approach. Further interventions, such as second-line eradication regimens, may be considered if the initial treatment fails to achieve successful eradication.