Is a diagnosis of gastroenteritis with persistent nausea, fever, diarrhea (bowel movement 1-2 times/day), abdominal pain, and weight loss of 3 kg in 1 month, despite treatment with Nexium (esomeprazole) 20 mg twice daily for 2 weeks, an indication for upper endoscopy?

From the Guidelines

Yes, an upper endoscopy is indicated in this case. The patient has persistent symptoms including daily abdominal pain after eating, nausea, and significant weight loss (3 kg in 1 month) despite a trial of Nexium 20 mg twice daily for 2 weeks with only mild improvement, as indicated by the guidelines on appropriate indications for upper gastrointestinal endoscopy 1. These concerning features, particularly the weight loss and persistent symptoms despite acid suppression therapy, warrant direct visualization of the upper gastrointestinal tract to evaluate for potential causes such as peptic ulcer disease, gastritis, esophagitis, or other pathologies. The history of recent gastroenteritis with ongoing symptoms suggests the possibility of post-infectious irritable bowel syndrome or other complications that require further investigation. Key points to consider include:

• Persistent symptoms despite acid suppression therapy
• Significant weight loss
• Recent history of gastroenteritis
• Need for direct visualization and potential biopsies to guide management. The endoscopy will allow for direct visualization of the esophagus, stomach, and duodenum, as well as the opportunity to obtain biopsies if needed to guide further management, in line with the recommendations from the working party of the joint committee of the royal college of physicians of London, royal college of surgeons of England, royal college of anaesthetists, association of surgeons, the British society of gastroenterology, and the thoracic society of Great Britain 1.

From the Research

Gastroenteritis Symptoms and Treatment

• The patient's symptoms, including nausea, fever, diarrhea, and abdominal pain, are consistent with gastrointestinal disorders such as Crohn's disease 2.
• The patient's weight loss of 3 kg in 1 month and daily abdominal pain after feeding may indicate a chronic condition 2.
• The use of Nexium 20 mg BID for 2 weeks with mild effect may suggest that the patient's symptoms are related to acid reflux or gastroesophageal reflux disease (GERD), but the underlying condition may be more complex 2.
• The decision to perform an upper endoscopy may be indicated to rule out other conditions such as Crohn's disease, ulcers, or other inflammatory bowel diseases 2.

Diagnostic Considerations

• The patient's symptoms, such as diarrhea, abdominal pain, and weight loss, are common presenting symptoms of Crohn's disease 2.
• The diagnosis of Crohn's disease is typically made with endoscopic and/or radiologic findings, and disease management is usually with pharmacologic therapy 2.
• The patient's symptoms and treatment history suggest that an upper endoscopy may be necessary to determine the underlying cause of their symptoms and to guide further treatment 2.