Supplemental Reading

Borum ML. Irritable bowel syndrome. Prim Care 2001;28:523-538.

Hatlebakk JG. Medical therapy. Management of the refractory patient. Gastroenterol Clin North Am 1999;28:847-860.

Huang JQ. Pharmacological and pharmacodynamic essentials of H(2)-receptor antagonists and proton pump inhibitors for the practicing physician. Ballieres Best Pract Res Clin Gastroenterol 2001;15:355-370.

Kromer W. Endogenous and exogenous opioids in the control of gastrointestinal motility and secretion. Pharmacol Rev 1988;40:121-162.

Smoot DT. Peptic ulcer disease. Prim Care 2001;28: 487-503.

Stein RB. Medical therapy for inflammatory bowel disease. Gastroenterol Clin North Am 1999;28:297-321.

Stotland BR. Advances in inflammatory bowel disease. Med Clin North Am 2000;84:1107-1124.

Wald A. Constipation. Med Clin North Am 2000;84:1231-1246.

Case Study Peptic Ulcer Disease

JK is a 32-year-old white woman who works as the administrative assistant to the chief executive officer of a large firm. She has two small children and describes her life as stressful. She smokes 1 pack of cigarettes per day. She frequently takes naproxen for headaches. For the past 5 weeks she has noticed significant epigastric discomfort. This morning she went to the emergency department complaining of hematemesis. She was admitted, and the gastroenterologist performed an upper en-doscopy that revealed a 1-cm ulcer. Is further evaluation necessary, and what recommendations would you make to this patient?

Answer: Peptic ulcer disease is most frequently secondary to either Helicobacter pylori infection or use of NSAIDs. The patient does admit to NSAID use (naproxen), but should also be checked for concomitant H. pylori infection at time of endoscopy or by a serology test. If the patient was found to have H. pylori, an appropriate eradication regimen should be prescribed. The patient should also be counseled to avoid NSAIDs. The patient should be prescribed a proton pump inhibitor for 8 weeks to heal the ulcer. A repeat endoscopy should be done at that time to document ulcer healing and rule out gastric cancer. In addition, the patient should be counseled to stop smoking, which is a risk factor for more severe peptic ulcer disease.

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