The symptoms of anorexia, heartburn, and weight loss are common for duodenal ulcer disease, functional dyspepsia, acute gastritis, alcohol related dyspepsia (ARD) as well as gastroesophageal reflux disease (GERD). All these conditions are difficult to diagnose correctly due to the variable nature of its presenting symptoms against those of other gastrointestinal illnesses. In this case, acute gastritis is ruled out technically by the fact that it presents with presence of blood in the stool and the test in this case did not indicate any blood stains. On the other hand, acute gastric presents with temporary pain in the stomach that do not last long while in this case, the pain is persistent particularly instigated by the heart burn (Fukudo, Kuwano & Miwa, 2012). Further, with functional dyspepsia, the symptoms of anorexia and weight loss are common but the main distinguish factor for functional dyspepsia is the persistent pain in the upper region of the belly and the ribs. In the presented case study, the pain is concentrated within the back region which then rules out the possibility of functional dyspepsia. In the case of GERD, heartburn and epigastric tenderness are some of the presenting symptoms that indicate such a possibility (Gadaleta, van Mil, Oldenburg, Siersema, Klomp & van Erpecum, 2010). However, GERD rarely presents with anorexia and weight loss and thus ruling out this diagnosis. The patient in this case has all symptoms that indicate the presence of alcohol related dyspepsia (ARD).similar to functional dyspepsia, ARD presents with symptoms of anorexia, weight loss and heart burn and it exacerbates with the continued consumption of alcohol. The back pain is usually associated with the heart burn which is felt in the lower region of the chest which the patient could easily indicate as back pain. The absence of blood in the rectal tests also supports the diagnosis of ARD (Gadaleta, van Mil, Oldenburg, Siersema, Klomp & van Erpecum, 2010).
The role the patient history and physical exam played in the diagnosis
In the management of gastrointestinal disorders, patient history provides a significant indication of the patient’s lifestyle and dietary techniques which usually are the triggers for the manifestation of these disorders. On the other hand, heart burn and ulcers are usually associated with anxiety, depression and stress all which can be determined through the patient’s history. Thus, the care team has to focus on the determining the all round social, economic and medical history of the patient (Jarvis, 2015). Ulcers and heart burn as well as stomach upsets are influenced by increased toxicity in the bowel which could be influenced by continuous medication as well as alcohol use. Physical examinations are vital in making a differential diagnosis since most of the gastrointestinal illnesses have similar presenting symptoms and only uniquely identifiable by minimal physical changes (Jarvis, 2015).
Treatment
With this patient, the first intervention is to withdraw the Rolands and TUMs medication and replace with a one-month trial acid suppressing medication, in this case omeprazole. However, with the patient regularly taking alcohol, the medication will not be effective in any way and could even further add to the toxicity of the bowel and thus increase the already presenting symptoms such as heart burn and acidity. The patient will thus be placed on a dietary plan to ensure regular meals as well as avoidance of alcohol (Fukudo, Kuwano & Miwa, 2012).
References
Fukudo, S., Kuwano, H., & Miwa, H. (2012). Management and pathophysiology of functional gastrointestinal disorders. Digestion, 85(2), 85-89.
Gadaleta, R. M., van Mil, S. W., Oldenburg, B., Siersema, P. D., Klomp, L. W., & van Erpecum, K. J. (2010). Bile acids and their nuclear receptor FXR: relevance for hepatobiliary and gastrointestinal disease. Biochimica et Biophysica Acta (BBA)-Molecular and Cell Biology of Lipids, 1801(7), 683-692.
Jarvis, C. (2015). Physical Examination and Health Assessment–. Elsevier Health Sciences.
