Gastrointestinal Case Histories - Case 20

A 45-year-old store manager complained of a burning, gnawing pain, moderately severe, almost always in the epigastric region. The pain is absent when he awakens, appears in midmorning, and is relieved by food but recurs two to three hours after a meal. The pain often awakens him at 1 or 2 a.m. An endoscopic examination and x-ray studies with barium showed normal stomach function but the presence of duodenal ulcers. Gastric analysis demonstrated that the gastric juice pH fell to 1.9 with pentagastrin stimulation (6µg/kg s.c.). Fasting serum gastrin levels were normal. Recommended treatments for this individual follow.

Antacids: 15-30 mL of liquid or two to four tablets one to three hours after each meal and at bedtime for six weeks.

Histamine (H2) receptor antagonists: cimetidine (300 mg) or ranitidine (150 mg) with each meal and at bedtime for four to eight weeks.

1. What is the diagnosis of this individual?

2. What is the significance of doing a pentagastrin stimulation test?

3. What is the significance of doing a fasting serum gastrin level?

4. What is the function of taking antacids?

5. How do the H2 antagonists act in treating this disorder?

6. What type of dietary and behavioral recommendations would also be suggested for this person?

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