24 YEAR OLD AND EXTENSIVE GASTRIC ULCERATIONS

Mr. ABC, 24 year old work IT Professional hailing from Odisha walks into the Med Gastro OPD with dyspeptic symptoms and says he has been having heartburn, vomiting and regurgitation since 1-2 months. He initially had heartburn and regurgitation in the last 3 months followed by mutiple episodes of non bilious non projectile vomiting, more after taking meals, not a/w coffee ground vomitus. He says he is on a strict diet and exercise training as a part of weight loss programme and has been taking home made
Menthi water for the same.

He doesn't give history of fever, loss of appetite, altered bowel habits, postprandial fullness, yellowish discolouration of eyes and skin, black colored stools, headache, neck rigidity.

He has no comorbidities. He consumes alcohol once in a while and doesn't smoke.

His parents and siblings are absolutely fine and he doesn't give any significant family history as such.

He is a non vegetarian. His bowel and bladder habits are regular. His appetite is good and has good sleep.

First visit in MGE and we decide to do an Oesophagogastroduodenoscopy on the same day.

We expected an ulcer to be seen but we see not one or two but Extensive gastric ulcerations as shown below.










HISTOPATHOLOGY EXAMINATION:




The histopathology examination report says Helicobacter pylori is negative and Presence of clear cells noted in biopsy specimens and hence close followup is required.

Our differentials included Gastric ulcer due to H.pylori, Crohns , Tuberculosis and Food granulomas.
We thought there is a possibility of food granulomas being formed as he gave history of consumption of menthi water daily, but no granulomas were seen on biopsy.

Then we started the patient on empirical Hp kit for 14 days. Patient came back with c/o vomiting after taking tablets for 2 days. We had to stop the Hp kit and resume him on PPIs.

We took a decision of repeating endoscopy again and this time take good biopsies from all over the stomach as per protocol.
We did a repeat endoscopy and the HPE report is awaited.


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