Case 37


A 22-year-old gentleman with good past health presents to the outpatient clinic with a longstanding history of epigastric discomfort. He has no regurgitation. He has a normal appetite and has had no weight loss. He has no change of bowel habit, per-rectal bleeding, tarry stools and abdominal pain. He is not taking any medications or herbs.

Physical examination

Temperature 37°C, pulse 72 bpm, BP 123/60mmHg, SaO2 98-100% on RA.

Hydration is satisfactory.

Examination of the hands reveals no clubbing and normal-appearing palmar creases.

Head and neck examination is unremarkable.

Cardiovascular: HS dual, no murmur.

His chest is clear on auscultation.

Abdominal examination reveals a soft, non-tender abdomen.

PR brown stool.

No signs of oedema.



WBC 9.3 x 109/L;

haemoglobin 12.3g/dL;

platelets 295 x 109/L.

What is your differential diagnosis of his epigastric discomfort?

Peptic ulcer disease.


Gastro-oesophageal reflux disease (GORD).

Malignancy (e.g. liver, oesophageal, gastric).

Pancreatic disease (chronic pancreatitis).


Functional dyspepsia.

The patient is given an 8-week course of high-dose proton pump inhibitors (PPIs) but the symptoms persist.

What would be the next investigation?

Oesophagogastroduodenoscopy (OGD).

An OGD is performed which shows antral gastritis. An antral biopsy is taken (Figure 37.1).


Please describe what you see

The biopsy shows antral gastritis with the presence of Helicobacter pylori (arrows).

What are the different diagnostic tests for Helicobacter pylori?

Different diagnostic tests for Helicobacter pylori include the following 1:


Rapid urease test (RUT).

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Oct 23, 2019 | Posted by in GASTROENTEROLOGY | Comments Off on 37

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