A 28 year old male accountant comes into the family practice clinic complaining of gnawing abdominal pain that occurs 1-3 hours after meals that is relieved by eating. The pain will wake him up in the morning. He says he often feels bloated with an increase in belching. These symptoms have been waxing and waning but last night he suddenly felt a severe mid-epigastric pain that radiates to the right shoulder. He localizes the pain to the epigastric region.
Labs: Gram stain smear of the gastric mucosa shows gram negative rods that are urease-positive.
Discussion: The diagnosis of duodenal ulcer (DU) is made by the clinical presentation. The presence of Helicobacter pylori is seen with a gram stain smear. The etiology of duodenal ulcers is multifactorial. The role of Helicobacter pylori in duodenal ulcers is unclear however Helicobacter pylori is present in >80% of duodenal ulcers. Infection with Helicobacter pylori is a risk factor for gastric carcinoma.
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