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CASE STUDY I:


Mrs S.W is 60 year old unemployed female. She smokes 20 cigarettes every day a drinks over 25 units per week. Had eradication therapy for H.pylori-assosiated duodenal ulcer 12 months ago.
ndShe was asymptomatic after treatment, but 6 monthes later she had recurrence of epigastric pain.
A (C14) urea breath test was positive.
She had a haemoglobin level 14,2 g/dl and a mean cell volume 102 fl

1) What further evaluation is needed?
2) What treatment will you recommend
?

Nado's picture
by
السنة الثانية


Thanks Nado

1. Endoscopy with biopsy
2. Repeat the cource of triple therapy

Dr. AIMB, can you help?

admin
معيد


Thanx for ur participation admin Laughing out loud
I wished that more would reply, but may be it wasnt that interesting or it was difficult Eye-wink

Admin this is typically for doctors; to answer in few words Eye-wink
but im happy to see ur reply.

1) She has failed eradication for H.pylori. The reasons for failure may be:
NON-COMPLIANCE WITH TREATMENT, DRUG RESISTENCE OR REINFECTION.
Her social circumstances and alcohol abuse may underlie poor adherence.
Most first-line eradication regimens contain metronidazole ;this will interact with alcohol and lead to side-effects, especially nausea and then discontinuation of therapy.
It is essential to know the exact drugs she had received, whether she had abstained from alcohol during therapy and whether she complied with the treatment.
Smoking reduces also the ulcer healing.
Confirmation of eradication by urea breath test is desirable, this is typical after treatment with regimens containing metronidazole.
MCV is high. This may be due to alcohol, but folate /vitamin B12 levels most be measured.
Epigastric pain may be due to pancreatitis/cholecystitis and need further investigations.
Abdominal ultrasonography is necessary.

2) She needs another course of eradication therapy with clarithromycin, amoxycillin and a PPI.
Culture and sensitivity testing of H.Pylori is soemtimes carried out in tertiary care centres, but in general unnecessary
.

Nado's picture
Nado
السنة الثانية
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