Question

A 45-year-old store manager complained of a burning, gnawing pain, moderately severe, almost always in the epigastric region. The pain is absent when he awakens, appears in midmorning, and is relieved by food but recurs two to three hours after a meal. The pain often awakens him at 1 or 2 a.m. An endoscopic examination and x-ray studies with barium showed normal stomach function but the presence of duodenal ulcers. Fasting serum gastrin levels were normal. H. pylori testing was negative. Treatments for this individual mightinclude the following: Antacids: 15-30 mL of liquid or two to four tablets one to three hours after each meal and at bedtime for six weeks. Histamine (H2) receptor antagonists: cimetidine (300 mg) or ranitidine (150 mg) with each meal and at bedtime for four to eight weeks. Omeprazole (proton pump inhibitor): 20 mg two times a day.

1. What is the diagnosis of this individual?

2. What is the significance of doing a fasting serum gastrin level?

3.What is the function of taking antacids?

4a. How do the H2 antagonists act in treating this disorder?

5. How does omeprazole act in treating this disorder?

6a. What is H. pylori?

7. Most person who are H. pylori positive do not develop ulcers. What host (patient) factors would increase the risk that colonization with H. pylori would lead to the development of ulcer?

8. How are most patients treated with positive H. pylori testing?

9. How do NSAIDs cause ulcers?

Answer 1

1. The Diagnosis of this individual is Peptic Ulcer .Peptic ulcer is defined as a break in the inner lining of the stomach after the wall in the inner epithelium of the stomach gets eroded .
2. Gastrin is a harmone which is secreted in the stomach to fuel the release of gastric acid .Gastrin release is inhibited by fasting and increased gastric acidity and is stimulated by a high gastric pH.So if a fasting serum gastrin is done it can measure accurately the level of serum gastric acid in the blood
3. Antacid is a substance which neutralizes the excess gastric acid that is produced by the stomach and which acts a protective barrier to dilute the amount of acid that is secreted by the stomach .It relieves heart burn ,Stomach upset ,Acid Indigestion .
4. Histamine Antagonist receptors which prevents or reduce the acid secretion and also the pepsin production .It also prevents the increase in secretion of the acid thereby inhibiting the parietal cells in the stomach to stop the production of acids  .
5. Omeprazole is a proton pump inhibitor .Its main action is to inhibits the gastric acid secretion by inhibiting the potassium pump which is located in the gastric parietal cell ,thereby inhibiting the the secretion of acid in to the stomach .
6. H.pylori is a gram negative bacteria which is found in the stomach .It is adapted to live in any acid secretions .It is previously called as Campylobacter Pylori .It is Micro-aerophilic in nature which requires oxygen .It plays an important role in stomach ecology .
7. Risk factors that are related for the colonization of the H.Pylori in the host are crowded conditions and also unclean drinking water.
   1. Poor host immune response
   2. Crowded place
   3. Unreliable  drinking water
   4. Cigarette smoking
   5. High salt consumption
8. Medications to be given such as antibiotics & Proton pump inhibitors ,A proper lifestyle with modified diet
9. NSAIDs when taken in large quantities cause damage to the gastro duodenal mucosa ,there by sppressing the gastric prostoglandin synthesis and reduction of gastric mucosal blood flow ,which results in the injury to the lining of the gastric layer .The presence of the acid in the stomach causes the pathogenesis which inhibits the secretion of the gastric acid .