Discussion Question 2: Is A 55-Year-Old Police Officer

Discussion Question 2tj Is A Fifty Five Year Old Police Officer Who Pr

Discussion Question 2tj Is A Fifty Five Year Old Police Officer Who Pr

Discussion Question 2 TJ is a fifty-five-year-old police officer presenting with two weeks of epigastric pain. Despite taking OTC Zantac, his symptoms persist. He has a prior diagnosis of a bleeding ulcer a year ago, which he did not complete treatment for, and he currently takes OTC NSAIDs for osteoarthritis. His lifestyle includes smoking one to two packs per week and consuming about one alcoholic beverage daily. His vital signs and blood work are normal. The questions posed include additional testing, potential contributing variables to his symptoms, treatment modifications, considerations for other diagnoses, and whether NSAID-induced ulcer prophylaxis is warranted.

Paper For Above instruction

Evaluation of a patient like Mr. TJ, a 55-year-old male with recurrent epigastric pain and a history of gastric ulcer, necessitates a comprehensive approach including further diagnostic assessments, lifestyle evaluation, and therapeutic adjustments. Given his persistent symptoms despite OTC therapy, the focus should be on both confirming the current diagnosis and identifying any underlying or concurrent conditions.

Additional Testing Recommendations

Initial assessments should include upper gastrointestinal endoscopy (esophagogastroduodenoscopy [EGD]) to directly visualize the mucosal surface, identify ulcer recurrence, or detect other pathologies such as malignancy. It is essential due to his history of bleeding ulcers, especially considering his current lack of symptom relief, which raises concern for recurrent or persistent ulceration. Non-invasive testing, such as Helicobacter pylori (H. pylori) testing, using a urea breath test, stool antigen test, or serology, should be performed because H. pylori is a significant etiological factor in peptic ulcers and may necessitate targeted eradication therapy. Additionally, laboratory tests including complete blood count (CBC) to assess for anemia, liver function tests, and serum amylase/lipase to rule out other gastrointestinal pathology could provide valuable information.

Variables Contributing to Symptoms

Several factors could be contributing to Mr. TJ’s symptoms. His history of non-compliance with ulcer treatment suggests a risk of recurrent ulceration due to unresolved H. pylori infection or continued NSAID use. NSAIDs decrease gastric prostaglandin synthesis, impairing mucosal defense and increasing ulcer risk, especially in older adults. Smoking further exacerbates mucosal injury by impairing mucosal blood flow and inhibiting mucus secretion. Alcohol consumption, even at modest levels, can irritate the gastric mucosa, aggravating ulcer symptoms. Moreover, his age and prior ulcer history suggest intrinsic risk factors for ulcer recurrence and potential bleeding. The prior incomplete therapy and ongoing NSAID ingestion significantly heighten his vulnerability to a repeat ulcer event.

Treatment Alterations and Recommendations

Management should focus on eradicating H. pylori if detected, discontinuing or substituting NSAIDs, and optimizing gastric mucosal protection. First, confirm H. pylori infection through non-invasive testing. If positive, prescribe a standard eradication regimen such as a proton pump inhibitor (PPI) combined with antibiotics (e.g., amoxicillin and clarithromycin). The use of PPIs is critical for healing ulcers and reducing gastric acid secretion.

Given his NSAID use for osteoarthritis, alternative pain management strategies should be considered. Non-NSAID analgesics, such as acetaminophen, might be safer, or if NSAIDs are necessary, co-prescription of gastroprotective agents like PPIs should be implemented to prevent ulcer re-rupture. For secondary prevention, PPIs or misoprostol can be employed for prophylaxis in patients with a history of complicated ulcers or recurrent ulceration.

Smoking cessation support and counseling about alcohol intake are also essential elements of comprehensive care, as these lifestyle modifications significantly influence ulcer healing and prevent recurrence. In addition, close follow-up should monitor symptoms and adherence to therapy, with repeat endoscopy reserved for persistent or complicated cases.

Prophylactic Measures for NSAID-Induced Ulcers

In patients like Mr. TJ, who require continued NSAID therapy, prophylaxis with PPIs or misoprostol is advisable to reduce the risk of ulcer development. Evidence indicates that PPIs are highly effective in preventing NSAID-associated ulcers and related bleeding (Lanza et al., 2009). Careful risk stratification helps tailor prophylactic strategies, balancing ulcer prevention against potential adverse effects. Additionally, patient education on medication adherence and lifestyle factors plays a crucial role in reducing recurrence risks.

Conclusion

Overall, managing Mr. TJ’s condition involves confirming the etiology of his symptoms through endoscopy and H. pylori testing, implementing targeted therapy such as eradication of infection, adjusting his NSAID regimen, and promoting lifestyle modifications. Prophylactic strategies, especially PPIs, should be employed for continued NSAID use, and close follow-up is necessary to ensure optimal outcomes. Addressing contributing variables such as smoking and alcohol use alongside pharmacologic interventions can significantly improve his prognosis and prevent future ulcer complications.

References

• Lanza, F. L., Chan, F. K., & Quigley, E. M. (2009). Guidelines for prevention and treatment of NSAID–associated gastric ulcers. The American Journal of Gastroenterology, 104(3), 728-738.
• Laine, L., et al. (2017). Management of nonsteroidal anti-inflammatory drug gastropathy and ulceration. Gastroenterology, 153(2), 319-334.
• Roşca, A., et al. (2021). H. pylori eradication strategies in peptic ulcer disease: A review. Journal of Clinical Medicine, 10(9), 1931.
• Sharma, P., et al. (2018). Diagnosis and management of peptic ulcer disease. Gastroenterology Clinics of North America, 47(4), 575-588.
• Sung, J. J., et al. (2011). Epidemiology of peptic ulcer and NSAID use: A systematic review. Annals of Surgery, 254(4), 544-553.
• Voutilainen, M. H. (2015). Gastroprotective strategies in NSAID therapy: Balancing risks and benefits. Best Practice & Research Clinical Gastroenterology, 29(6), 937-951.
• Wallace, J. L. (2018). Prostaglandins, NSAIDs, and gastrointestinal mucosal protection. Gastroenterology, 154(5), 1206-1216.
• Whittington, R. J., et al. (2016). Risk factors for NSAID gastropathy: A focus on age and comorbidities. Journal of Gastroenterology, 51(4), 343–357.
• Yeomans, N. D. (2008). Peptic ulcer disease management now and in the future. World Journal of Gastroenterology, 14(41), 6173-6179.
• Zhang, X., & Labenz, J. (2020). Guideline update on NSAID-related gastrointestinal risk management. Clinical Gastroenterology and Hepatology, 18(4), 651-656.