Case History 4 

A 49 year old woman presented to the emergency room complaining that she had vomited up blood at home. She had been suffering with sharp epigastric pain, especially in the morning, for one week before the vomiting began. The pain was accompanied by mild nausea and was relieved by food or antacids.  She had a long history of peptic ulcer disease and was initially diagnosed with duodenal ulcer at age16.  Despite

 at least six discrete episodes of ulcer documented by x-ray or endoscopy, she had never undergone surgery. Workup for Zollinger-Ellisonsyndrome (a gastrin producing pancreatic adenoma) was negative.

 

A nasogastric tube was placed revealing blood in the stomach which cleared after gastric lavage with iced saline. Immediate endoscopy

 revealed scarring of the pylorus with a 2 cm ulcer in the first portion of the duodenum. Biopsy of the ulcer revealed curved bacilli with

 Warthin‑-Starry silver staining and a positive urease test.

 

Case 4 Questions

 

  1. Describe the morphologic and microbiologic features of Helicobacter pylori?  Answer
  2. What is the frequency of infection with H. pylori in the United States? How does the distribution of H. pylori infection differ in populations from underdeveloped countries?  Answer
  3. What phenotypic characteristics of H. pylori are thought to account for its virulence?  Which of  them appear to be most important?  Answer

 

The nasogastric tube aspirate remained blood free and the tube was removed. She was started on an H2 blocker and the pain rapidly subsided.

 

  1. What further treatment might be helpful?  What long term benefits could she expect if she were to receive the additional treatment?  Answer