54 year old male teacher ...

54 year old male teacher by occupation with DM and on OHA having symptoms of Dyspepsia with recurrent Vomiting, Malena & H /O Significant weight loss since last one month. Patient referred to us for detailed evaluation . On per abdominal examination upper abdomen slightly distended with succession splash present. No lymphadenopathy. He was anaemic. OGD scopy revealed presence normal cardia. Significant liquid and semisolid gastric residue seen. Antro-duodenal channel deformed with prominent mucosal thickening noted at duodenal bulb region. Multiple biopsies taken from abnormal appearing thickened area for detailed evaluation and sent for HPE. Duodenal
bulb mucosal erythema with ulceration noted . D1 and D2 junction shows significant luminal narrowing , scope could not be negotiated through it. D2 segment of duodenum not seen. He was advised CT (Abdomen + Pelvis) Oral + IV contrast Study. The patient CECT findings suggestive of Gastric Outlet obstruction. Endoscopic biopsy HPE report showed- Chronic active peptic duodenitis with gastritis due to H. Pylori. Patient started with Triple Regime( Clarithromycin +PPI+ Amoxicillin) anti- H Pylori Kit and continued for 14 days along with diet and lifestyle modifications. Patient tolerated diet and medications and after 3-4 days his symptoms started improving. There were no H/O vomiting in follow-up visits along with he started to gain weight. We kept this patient on Long term PPI + Prokinetics and OGD scopy repeated after 2 months . OGD scopy revealed presence few mucosal breaks which were < 5 mm in length at lower oesophagus .Mild lax cardia. Approximately 25-30ml bilious gastric residue noted. An Adequate gastric distensibility on air insufflation noted. Significant bile reflux seen. Gastric mucosa oedematous, congested with evidence few erythema’s at gastric fundus and body region. Presence of sticky mucus. Patchy atrophic mucosal changes noted at antral and corpus region of stomach. Rapid Urease test for H. Pylori " NEGATIVE".
Mild mucosal oedematous changes with few minor erosions noted at duodenal bulb. Mild deformed duodenal bulb. Scope passed with mild difficulty into D2 segment of duodenum. There were no evidence of luminal narrowing inbetween D1 & D2 segment as seen in previous scan. PPI + Prokinetics continued for 3-4 months and patient improved clinically better. There were no need of any therapeutic intervention for duodenal stenosis.