A 50-year-old college professor consulted his primary health-care provider because of tiredness, lethargy, and an abdominal pain centered around the lower end of his sternum, which woke him in the early hours of the morning. The pain was relieved by food and antacids. His uncle had died of stomach cancer and he was worried that he had the same illness.
Abdominal pain has an extremely broad differential diagnosis list. Certain features often help in determining which is the most likely etiology. Lower-right quadrant pain suggests appendicitis, whereas upper-right quadrant pain is suggestive of cholecystitis or cholelithiasis. The absence of diarrhea or emesis makes gastroenteritis and Crohn disease unlikely. Esophagitis or reflux disease would likely have chest pain as a prominent symptom. Pain associated with signs of acid hypersecretion suggests peptic ulcer disease. However, these are generalizations. and other factors, such as lab results and endoscopy should be considered.
On examination his doctor noted that he seemed a bit pale and that he had a tachycardia. His blood pressure was low. He was slightly tender in his upper abdomen but there was no guarding or rebound tenderness. The doctor took blood and fecal samples. The complete blood count (CBC) showed a hypochromic normocytic anemia with a hematocrit of 38% and a hemoglobin of 8.9 gram/100 mL consistent with iron deficiency anemia. The fecal antigen test for the suspected microorganism was positive as was the 13C urea-breath test.
An upper gastrointestinal endoscopy was conducted and the gastroscopic exam showed a 3cm ulcer in the prepyloric region of the stomach. PCR (polymerase chain reaction) analysis of the gastric biopsy confirmed the identity of the microorganism. The patient was started on routine treatment for a duodenal ulcer.
Describe the likely causative microbial agent and how it causes the disease presentation.
What is the route of infection? Is it contagious? If so, how can it be spread?
What is the treatment regimen for this disease?
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