Case Study: Gastrin Dysregulation in Peptic Ulcer Disease
Patient Background:
Mr. Smith, a 54-year-old male, presents to the gastroenterology clinic with complaints of recurrent abdominal pain, particularly after meals, along with occasional episodes of heartburn and acid reflux. His medical history is significant for smoking (10 pack-years), occasional alcohol consumption, and a family history of peptic ulcer disease (PUD). Upon further questioning, Mr. Smith reports experiencing these symptoms intermittently over the past six months, with increasing severity and frequency.
Clinical Presentation:
During the initial evaluation, Mr. Smith’s vital signs are within normal limits, and physical examination reveals epigastric tenderness upon palpation. Laboratory investigations, including complete blood count and liver function tests, are unremarkable. However, a serum gastrin level is found to be elevated, prompting further evaluation for possible gastrinoma.
Diagnostic Workup:
Given the suspicion of gastrin dysregulation, additional investigations are pursued to elucidate the underlying etiology of Mr. Smith’s symptoms. Upper gastrointestinal endoscopy reveals the presence of multiple gastric ulcers in the antrum and body of the stomach, consistent with peptic ulcer disease. Biopsies obtained during endoscopy confirm the absence of Helicobacter pylori infection but demonstrate hypertrophic changes in the gastric mucosa suggestive of chronic hypergastrinemia.
Further Evaluation:
To further characterize the extent of gastrin dysregulation, additional diagnostic tests are performed. A fasting gastric acid output test reveals elevated acid secretion, corroborating the clinical suspicion of hyperchlorhydria. Additionally, imaging studies, including abdominal ultrasound and magnetic resonance imaging (MRI), are conducted to rule out the presence of gastrinoma or other pancreatic neoplasms. Fortunately, no evidence of an underlying tumor is identified.
Treatment and Management:
In light of the diagnosis of peptic ulcer disease secondary to gastrin dysregulation, a multidisciplinary approach is adopted to optimize Mr. Smith’s management. Initially, proton pump inhibitor (PPI) therapy is initiated to suppress gastric acid secretion and promote ulcer healing. Lifestyle modifications, including smoking cessation and dietary modifications to avoid spicy and acidic foods, are also recommended to minimize symptom exacerbation.
Follow-Up and Prognosis:
Over the subsequent weeks, Mr. Smith demonstrates significant improvement in his symptoms, with resolution of abdominal pain and reduction in episodes of acid reflux. Follow-up upper gastrointestinal endoscopy reveals marked improvement in ulcer healing, consistent with the effectiveness of PPI therapy. Serial monitoring of serum gastrin levels demonstrates a gradual decline, indicating successful suppression of hypergastrinemia. Mr. Smith is advised to continue PPI therapy and undergo regular surveillance endoscopies to monitor for ulcer recurrence and assess treatment response.
Discussion:
This case highlights the intricate interplay between gastrin dysregulation and peptic ulcer disease, emphasizing the importance of recognizing and addressing underlying pathophysiological mechanisms in the management of PUD. By elucidating the role of gastrin in gastric pathology, clinicians can implement targeted therapeutic strategies to alleviate symptoms, promote ulcer healing, and prevent disease progression. Additionally, this case underscores the significance of comprehensive diagnostic evaluation, including endoscopic and biochemical assessment, to tailor treatment approaches based on individual patient characteristics and disease severity. Through collaborative efforts between clinicians, gastroenterologists, and allied healthcare professionals, optimal outcomes can be achieved for patients with gastrin-mediated peptic ulcer disease.