FNP 591 Week 4 Aquifer Case Study: Family Medicine

Family Medicine 19: 39-Year-Old Man with Epigastric Pain

Student name

United States University

FNP-591

Professor Name

Submission Date

39-Year-Old Man with Epigastric Pain

A patient who experienced terrible epigastric pain is a 39-year-old man, a Dominican immigrant, whose symptoms have exacerbated during the last year. He explained that his epigastric pain was a burning pain in the epigastric area. His symptoms do not necessarily coincide with meals, and he does not necessarily have GERD symptoms. Mr. Rodriguez is a regular user of ibuprofen, who occasionally consumes wine and occasionally drinks herbal tea. The physical examination reveals that the patient has only some epigastric tenderness when palpated. Omeprazole was also unsuccessful, and IgG antibodies of Helicobacter pylori showed an existing infection.

Diagnosis with Rationale

PUD is the main diagnosis.

Rationale

Consequently, Mr. Rodriguez is at risk of having peptic ulcer disease due to persistent epigastric discomfort, NSAID use, and association with H. pylori IgG antibodies. Direct damage to the stomach or duodenal mucosa may be caused by H. pylori infection or the use of NSAIDs, thus leading to PUD, which is also known as a peptic ulcer (Perico et al., 2020).

Differential Diagnosis

Gastritis

Gastritis was sought because Mr. Rodriguez had continuous symptoms and took NSAIDs that may worsen the lesion of the gastric mucosa (McEvoy et al., 2021). Without significant nausea, vomiting, or hematemesis, this diagnosis is less likely.

Functional dyspepsia

Functional dyspepsia was also included in the list of diagnoses because of persistent epigastric pain that was not related to meals (Black et al., 2022). But, without reaction to omeprazole and with the positive H. pylori IgG antibodies, functional dyspepsia was eliminated.

Diagnostic Plan

Active Infection Confirmation

Mr. Cesar Rodriguez should be given a non-invasive test to prove that he has an active Helicobacter pylori (H. pylori) infection before this medication is administered (Dore & Pes, 2021). Non-endoscopic tests to be used to diagnose active H. pylori infection are the urea breath test and stool antigen test.

Urea Breath Test

 Another diagnostic test of H. pylori that is often used and is easy to perform is the urea breath test. A radioactive or non-radioactive tracer (say, urea) is ingested by patients (Alzoubi et al., 2020). The H. pylori in the stomach makes use of the urea breath test, whereby a tagged carbon dioxide is produced in the breath of the patient. It is rapid, sensitive, and specific, and the results are produced in the least time possible (Alzoubi et al., 2020).

 Stool Antigen Test

 The H. pylori antigens are detected by stool antigen tests. Once again, the method is noninvasive and has a high sensitivity and specificity in the diagnosis of the current H. pylori infection (Cardos et al., 2022). It does not require special tools and examples, hence it is suitable in primary care.

 Importance of Confirmation

 Active H. pylori infection should be excluded prior to starting the treatment so that it is possible not to waste antibiotics, and so that the intended treatment is administered. Breath urea hydrogen test and stool antigen test belong to first-line tests since they are reliable and cause no harm to the patient (Costa et al., 2024). These tests are useful in the process of choosing the antibiotics that will be used to treat the given condition.

A Treatment Plan

1. The evidence-based practice suggests using quadruple therapy to address H. pylori infection in areas with a high prevalence of clarithromycin resistance: PPI, amoxicillin, clarithromycin, and metronidazole or tinidazole (Gupta et al., 2023). In case the initial treatment of Mr. Rodriguez was not effective, then it should be replaced with levofloxacin instead of clarithromycin.
2. The treatment plan for Mr. Rodriguez is:
3. PPIs: PPIs, including omeprazole, should be used to reduce the quantity of stomach acid and heal ulcers (Gupta et al., 2023).
4. Keep 3–5g of amoxicillin (H. pylori) during antibiotic therapy.
5. Levofloxacin: A replacement for clarithromycin is prescribed when the patient is not responding to the previous treatment regimen to avoid the development of antibiotic resistance.
6. Bismuth Subsalicylate: To increase the protective properties of the mucosa and the effectiveness of the drug delivery (Gupta et al., 2023).

 Conclusion

 The example of Mr. Cesar Rodriguez shows that it is essential to identify H. pylori infection in patients with chronic epigastric pain, especially when they have modifiable risk factors, such as NSAID use and immigrant status in the country where the patients have immigrated. The timely diagnosis and treatment are the key to the prevention of complications in PUD. Frequent follow-ups and counseling of patients should be included in his management to contain and reduce warning symptoms.