The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.
A 35-year-old woman presents with epigastric pain of 2 months' duration. The pain is gnawing in character and is referred to the back; it is sometimes associated with a sense of severe fullness and dyspnea after meals. During the past week, she has also noticed abdominal distention, with an increasing contour.
In addition, for the past 3 months, she has had severe postprandial dyspepsia that is not relieved by antacids. During the same period, she has lost 6 kg (13.2 lb) unintentionally. She also has occasional vomiting, which she sometimes induces to relieve the pain. The vomiting is preceded by nausea. Proton pump inhibitors and prokinetic drugs were prescribed, and she has been taking them for the past month, with only partial relief of her symptoms.
Her diet consists mainly of dairy products and vegetables, as she has been a vegetarian for the past 2 years. Her physician has prescribed complementary vitamin supplements for her since she adopted a vegetarian diet, but she does not take them regularly.
For the past 5 years, the patient has had osteoarthritis of the large joints, for which her physician prescribed a daily dose of celecoxib and an on-demand ibuprofen intramuscular injection. She does not smoke and occasionally drinks alcohol. Her menses are regular, with 4 days of moderate menstrual bleeding. She is not on any contraceptive regimen, either oral or local, such as an intrauterine device.
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Cite this: Sarah El-Nakeep. Dyspepsia in a 35-Year-Old Vegetarian With Osteoarthritis - Medscape - Aug 14, 2023.