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Review Question - QID 204623

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QID 204623 (Type "204623" in App Search)
A 48-year-old gentleman presents to his primary care physician complaining of epigastric pain and excessive belching. He states that he has recently been having black, tarry stools. An upper endoscopy is performed and reveals a gastric ulcer. How would food most likely affect this patient?

All food would make his pain better

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All food would make his pain worse

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All food will have no effect on his pain

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Acidic foods would improve his pain

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Basic foods would improve his pain

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Select Answer to see Preferred Response

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The patient in the above vignette has gastric ulcer as per the upper endoscopy. Pain from gastric ulcers worsen with food intake (as compared to duodenal ulcers that improve with food intake).

Peptic ulcer disease is a general term describing the damage to the gastric or duodenal mucosa. Gastric ulcers are not caused by acid hypersecretion as some typically think. Instead, it is the duodenal ulcers that are caused by acid hypersecretion and H. pylori is found in >90% of duodenal ulcers. It is classic for gastric ulcers to present with worsening pain upon ingestion of foods. Conversely, duodenal ulcers improve with food intake.

Ramakrishnan et al. discuss peptic ulcer disease (PUD). PUD is a disease of the stomach and proximal duodenum that is often caused by Helicobacter pylori infections and use of NSAIDs. Patients often present with epigastric pain, loss of appetite, and weight loss. Surgical intervention is used only in cases that develop complications or if it is refractory to medications.

Demetrashvili et al. compare intravenous pantoprazole with intravenous ranitidine in peptic ulcer re-bleeding after endoscopic therapy. Re-bleeding after successful endoscopic therapy ranges from 4-30% and remains the most important determinant of poor prognosis. After endoscopic treatment of bleeding peptic ulcers, intravenous pantoprazole was found to be more effective than ranitidine for the prevention of re-bleeding.

Illustration A depicts an endoscopic view of a deep gastric ulcer.

Illustration B is an overview image of various ulcer locations in the gastrointestinal tract.

Illustration C is a side-by-side picture of a duodenal ulcer and a gastric ulcer with an associated image of where the endoscope is placed for viewing of each ulcer.

Incorrect Answers:
Answer 1: Duodenal ulcers improve with food ingestion.
Answer 3: Gastric ulcers are usually made worse with food ingestion.
Answers 4,5: Gastric ulcers are usually made worse with food ingestion, regardless of the type of food ingested.

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