Patient PR presents with a sudden onset of intermittent mid-epigastric pain that has been occurring for the past 4 weeks. The pain is described as burning and has a severity of 6/10 on the pain scale. PR reports that the pain worsens after eating Mexican food and when lying down. This pain is a new experience for PR, who has been taking over the counter (OTC) antacids that initially provided relief but are no longer effective. PR also reports associated symptoms of regurgitation, feeling of fullness, and a recent sore throat.
Based on the patient’s presentation, the top three differential diagnoses for PR’s symptoms could include gastroesophageal reflux disease (GERD), peptic ulcer disease, and gastritis.
GERD is characterized by the backward flow of stomach acid into the esophagus, resulting in symptoms such as heartburn, regurgitation, and chest pain. The burning pain that worsens after eating and lying down, as well as the associated symptoms of regurgitation and feeling of fullness, are consistent with GERD (Rubenstein & Chen, 2019).
Peptic ulcer disease (PUD) is marked by the presence of ulcers on the lining of the stomach or duodenum. Symptoms can include abdominal pain, which may be described as burning or gnawing, and may be relieved or worsened by eating. The intermittent nature of the pain and the fact that it worsens after eating could be indicative of PUD (Lanas & Chan, 2017).
Gastritis refers to inflammation of the stomach lining and can be caused by various factors including infection, medications, or autoimmune conditions. The burning pain and associated symptoms reported by PR are consistent with gastritis, as these symptoms often result from inflammation in the stomach (Kusters, van Vliet, & Kuipers, 2006).
To accurately diagnose PR’s condition, certain diagnostic tests may be needed. These could include an upper gastrointestinal (GI) endoscopy, which allows for direct visualization of the esophagus, stomach, and duodenum to identify any abnormalities or signs of inflammation. Additionally, a biopsy of the stomach lining may be performed during the endoscopy to check for the presence of H. pylori infection, a common cause of gastritis and PUD (Laine et al., 2017). Other diagnostic tests that could be considered include a barium swallow or pH monitoring to assess acid reflux into the esophagus.
As for the treatment of PR’s condition, it would depend on the specific diagnosis. If GERD is confirmed, pharmacological therapy could include proton pump inhibitors (PPIs) such as omeprazole, which reduce gastric acid production and help alleviate symptoms (Rao et al., 2019). Nonpharmacological measures for managing GERD could include lifestyle modifications such as avoiding trigger foods, elevating the head of the bed, and losing weight if necessary (El-Serag & Kahrilas, 2020).
In the case of peptic ulcer disease, treatment would involve a combination of medications to reduce acid production and eradicate H. pylori infection, if present. Proton pump inhibitors and antibiotics such as amoxicillin and clarithromycin are commonly used in this context (Malfertheiner et al., 2017). Nonpharmacological measures such as stress reduction and smoking cessation may also be recommended to aid in the healing process and prevent ulcer recurrence.
If gastritis is the confirmed diagnosis, treatment may involve the use of gastric acid suppressants such as PPIs or histamine-2 (H2) receptor blockers like ranitidine to reduce acid production and promote the healing of the stomach lining (Chey et al., 2017). Avoidance of irritants such as NSAIDs and alcohol, as well as dietary modifications, may also be recommended to manage symptoms and support healing.
In conclusion, the top three differential diagnoses for PR’s symptoms are GERD, peptic ulcer disease, and gastritis. To confirm the diagnosis, diagnostic tests such as upper GI endoscopy may be required. The treatment approach will depend on the specific diagnosis, with options including pharmacological, nonpharmacological, and/or nutraceutical therapies. Proper identification and management of PR’s condition will help alleviate her symptoms and improve her overall quality of life.
References:
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