An Interesting Finding in Upper Gastrointestinal Endoscopy

Abstract

Here we report a case of a 62-year-old man who presented to the gastrointestinal clinic during the past 6 months with symptoms of chronic abdominal pain, accompanied by dyspepsia and weakness. He suffered from type 2 diabetes and hypertension and had received drug treatment for both diseases. Over the past year, he had repeatedly taken non-steroidal anti-inflammatory drugs (NSAIDs) due to arthralgia without the use of gastric acid inhibitors. He refused the presence of melena or bleeding when describing his condition. Physical examination showed that he only had a sensitivity of the upper abdomen, and in blood tests, microcytic anemia with serum iron level 7.1 μg/dL and iron deficiency with serum ferritin level 10 ng/mL, and hemoglobin 10.1 g/L were detected. He was examined for gastrointestinal microcytic anemia and the symptoms. Esophagogastroduodenoscopy showed normal esophagus, erosive gastritis, normal duodenum, and Double pylorus. Colonoscopy was normal. The endoscope passed both channels separately and the bulb of the duodenum was seen. (figure 1). The patient's double pylorus was confirmed by contrast radiography (figure 2). Also, urea testing of rapid Helicobacter pylori was conclusive, while histological studies of the gastric corpus and antrum revealed that chronic active gastritis was present in both and many Helicobacter pylori bacteria were found in H&E staining. The patient was treated to eradicate Helicobacter pylori with clarithromycin 500 mg, amoxicillin 1 g, and omeprazole 20 mg, twice daily for 14 days. Eradication was confirmed by a carbon-13 breath test, two months after treatment. Proton pump inhibitors were continued to be used once daily and NSAIDs use was restricted. Symptoms disappeared after a few weeks of treatment and the patient's anemia normalized after 6 months of treatment with the iron pill.