A47-year-old man with chronic low back pain presents to the emergency department with epigastric pain for 3 weeks. the pain is burning, without radiation and occurs 2-3 hours after eating. vital signs are normal. he takes ibuprofen and naproxen for his back pain. what management is indicated?

The patient presents synptoms of clinical gastritis secondary to the use of non-steroidal anti-inflammatory drugs.  Ranitidine and esomerprazole would be the medications to solve the case, and endocospy, if it is really necessary, considering the advanced stage of  his epigastric pain. Moreover, the patient should avoid spice food, alcohol, smoking, steroids and ibuprofen.

Explanation:

Because the diagnosis for gastritis can only be positive after a endoscopy, since the disease is an inflammatory condition of the gastric mucosa.  Physicians, use to do biposy in this case too. However, since the patient's pain occurs on the upper abdomen  and presents as bloating or heartburn, the doctors can also consider the possibility of dyspepsia.

They should prescribe a special diet for the patient, warning him to avoid: spice food, fat, alcohol, smoking, steroids and ibuprofen. Moreover, they should prescribe ranitidine and esomerprazole to threat the dyspepsia, and referral to a gastroenterologist for consideration of an upper endoscopy is reasonable.

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