33-Year-Old Female with Recurrent Upper GI Symptoms Post-H. pylori Treatment

Case at a Glance

A 33-year-old female presents with recurrent epigastric pain and upper gastrointestinal symptoms 18 months after initial H. pylori treatment, with recent endoscopic findings showing erosive gastroduodenitis and esophageal changes requiring biopsy evaluation.

Patient's Story

The patient is a 33-year-old female with a BMI of 18.1 who initially presented with stomach-related symptoms approximately 18 months ago. She was diagnosed with H. pylori infection and completed appropriate eradication therapy. Follow-up endoscopy confirmed successful H. pylori eradication, and she was subsequently diagnosed with gastroesophageal reflux disease (GERD). The patient experienced symptom resolution for several months but developed recurrent epigastric pain approximately two months prior to current presentation. Despite a negative urea breath test, she requested repeat endoscopic evaluation due to persistent symptoms.

Initial Assessment

Patient presented with recurrent upper abdominal pain in the setting of previous H. pylori infection (successfully treated) and known GERD. Physical examination revealed a thin female patient weighing 110 pounds. Given the history of H. pylori and recurrent symptoms, differential diagnosis included H. pylori reinfection, peptic ulcer disease, erosive gastritis, and complications of GERD including possible Barrett's esophagus or esophageal stricture.

The Diagnostic Journey

Initial workup included a urea breath test which was negative for H. pylori reinfection. Due to persistent symptoms and patient concern, upper endoscopy was performed. The procedure revealed superficial ulcerations (erosions) in both the stomach and duodenum. Additionally, esophageal abnormalities were noted and required tissue sampling for histopathological evaluation. Gastric biopsies were also obtained to rule out H. pylori reinfection.

Final Diagnosis

Pending final biopsy results. Current findings consistent with erosive gastroduodenitis with esophageal changes of unclear etiology requiring histopathological confirmation.

Treatment Plan

Patient was started on proton pump inhibitor (PPI) therapy for 8 weeks, followed by transition to H2-receptor antagonist (famotidine) for maintenance therapy. Plan includes follow-up for biopsy results and symptom reassessment. Patient counseled regarding findings and advised that esophageal biopsy is routine practice for abnormal appearing tissue and does not necessarily indicate malignancy.

Outcome and Follow-up

Patient is awaiting biopsy results with scheduled follow-up appointment. Initial anxiety regarding potential malignancy was addressed with appropriate counseling about the routine nature of tissue sampling during endoscopy. Compliance with prescribed PPI therapy emphasized for optimal healing of erosive lesions.