From the Guidelines
The workup for this 29-year-old female with symptoms suggestive of peptic ulcer disease should begin with a thorough history and physical examination, focusing on the abdominal area, and initial testing should include a complete blood count, comprehensive metabolic panel, and a stool test for Helicobacter pylori antigen, as recommended by the British Society of Gastroenterology guidelines 1. The patient's symptoms of intermittent upper abdominal discomfort, worse on an empty stomach and improving with eating, are consistent with peptic ulcer disease. Given her frequent ibuprofen use, which is a risk factor for peptic ulcer disease due to its inhibition of prostaglandins that protect the gastric mucosa, she should be advised to discontinue NSAIDs immediately. Some key points to consider in the workup and management of this patient include:
- The use of NSAIDs, such as ibuprofen, increases the risk of gastrointestinal complications, including peptic ulcers, as noted in several studies 1.
- The patient's risk factors for peptic ulcer disease, including her age, sex, and NSAID use, should be taken into account when determining the best course of management.
- A trial of a proton pump inhibitor (PPI) such as omeprazole 20mg once daily for 4-8 weeks would be reasonable, as PPIs have been shown to be effective in reducing the risk of NSAID-associated gastrointestinal complications 1.
- If H. pylori testing is positive, triple therapy should be initiated, typically consisting of a PPI, amoxicillin, and clarithromycin, as recommended by the British Society of Gastroenterology guidelines 1.
- Lifestyle modifications, including avoiding spicy foods, alcohol, caffeine, and eating smaller, more frequent meals, may also be beneficial in managing the patient's symptoms.
- Further investigation with imaging studies like an abdominal ultrasound may be warranted if symptoms persist despite these interventions, to rule out other causes of upper abdominal pain.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Initial Assessment
- The patient, M.K., presents with intermittent upper abdominal discomfort, which is worse on an empty stomach and improves with eating.
- She denies any nighttime awakenings, vomiting, blood in stool or emesis, fever, diarrhea, constipation, or weight loss.
- She has been taking ibuprofen frequently for menstrual cramps and headaches.
Diagnostic Considerations
- The patient's symptoms suggest peptic ulcer disease, which is often caused by Helicobacter pylori infection 2.
- A complete blood count (CBC) with differential can provide information about the patient's oxygen-carrying capacity, immune system, and help diagnose conditions such as anemia, infection, or blood dyscrasias 3, 4, 5, 6.
Workup Steps
- Obtain a complete medical history, including the patient's use of nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen.
- Perform a physical examination to assess for abdominal tenderness or other signs of peptic ulcer disease.
- Order a CBC with differential to evaluate for anemia, infection, or other conditions that may be contributing to the patient's symptoms 3, 4, 5, 6.
- Consider ordering a urea breath test to diagnose Helicobacter pylori infection, which is a common cause of peptic ulcer disease 2.
- If the patient's symptoms persist or worsen, consider further evaluation with endoscopy or other diagnostic tests.