TRIGGER

Case scenario:

Sunita, Indian lady of 52-year-old presented to her General Practitioner with pain & burning
sensation in the chest & upper abdomen which radiated to the neck for about 4 months.
PATIENT INFORMATION SHEET 1

History of present illness:

The pain appeared when lying on bed with full stomach. She had some trouble in swallowing
food and the food seemed to get stuck on its way down in the lower part of throat. She could
not take adequate food the last few days. For this, the GP suggested her to take antacid,
which relieved a little bit of her problem.

Past medical history:

She had been suffering from frequent loose motions for the past 20 years and had been taking
metronidazole for this problem.

Family history:
Nil of significant

Personal / social history:

The patient is a chronic smoker (30 cigarette/ day) for about 35 years (52 pack year). She
drinks a small glass of alcohol and spicy food every weekend before going to the bed.
PATIENT INFORMATION SHEET 2

Physical Examination

General Examination:
Anaemia: ++ Jaundice: Nil
Cyanosis: Nil Oedema: Nil
Dehydration: Nil
Height: 135 cm Weight: 60 kg

Vital Signs:
Blood pressure: 140/80 mmHg
Pulse rate: 80 per minute, regular rhythm
Respiratory rate: 16 per minute
Temperature: 36.9°C

Systemic Examination

CVS exam: S1 S2 heard normally. Dual rhythm no murmur

Respiratory system: No abnormalities are detected on examination of the chest.

Abdominal exam: No scars, no striae, Tenderness (++) at the epigastric region. No hernia,
no bruit, normal bowel sound, no hepatosplenomegaly, non-ballotable kidney.

All other body systems are normal

PATIENT INFORMATION SHEET 3

Laboratory Investigations:

Full blood count:

Parameters Test value Normal range

Haemoglobin 12.0g/dL 14.0-17.0g/dL
WBC 12.0x 109/mm3 4-10x109/mm3
Mean cell volume 70.9 fl 77.0-90.0 fl
MCH 24.4 pg 26.0-32.0 pg
MCHC 29.3 g/dL 32.0-36.0 g/dL
Neutrophil 8x109/L 2-7 x109/L
ESR 45 mm in 1st hour 1-15 mm in1st hour

Comment on PBF: ?

Cardiac enzymes:
AST 10 IU/L 5-43 IU/L
LDH 150 IU/L 140-280 IU/L

ECG- no abnormality is detected.

Xray chest P/A view- no abnormality is detected.

Barium swallow esophagus- mild narrowing of esophagus, also there is evidence of hiatal
hernia.

She was subsequently referred to a gastroenterologist for her problem. The gastroenterologist
then performed endoscopy of esophagus & stomach to view the extent of the lesion and took
biopsy.

1. Endoscopic finding:

The lining of the oesophagus is inflamed (esophagitis) with superficial erosions and ulcers.
2.Histopathological study of the biopsy (taken from affected oesophageal lesion):

H&E stain of lower oesophagus showing intestinal metaplasia

PATIENT INFORMATION SHEET 4

The patient was diagnosed as a case of GERD with Barrett’s oesophagus

Management and prognosis:

Based on the histopathological report,the gastroenterologist decided to give

 antacids
 proton pump inhibitor
 prokinetic drugs

The patient was advised to modify her lifestyle by the gastroenterologist. The risk factor for
developing this problem was discussed and informed her of the importance of knowing these
factors.

She was informed to come to the clinic for periodic check-up with endoscopic examination
for further evaluation. There is some chance of developing carcinoma at the lesion involved.