What additional testing would you suggest at this point

The patient has ulcers in his stomach and duodenum. While epigastric pain is the most common symptom of peptic ulcer disease (PUD), the burning sensation is insufficient to distinguish the disease from a variety of other disorders that share the typical symptom, necessitating an endoscopic confirmation test. The invasive diagnostic is required because an accurate visual image is required to identify the degree of current bleeding (Ghimire, Ghimire, Goel, & Bahl, 2015). While endoscopy is the recommended method of diagnosis, non-invasive testing should also be considered. For example, fecal antigen testing is a less expensive and more effective alternative to imaging. Measuring the level of hormone gastrin in the serum is important in screening possibility of Zollinger-Ellison syndrome in TJ’s case because of the recurrence. The routine laboratory test is necessary for establishing the causal factors.

Describe any and all variables that could be contributing to his symptoms

TJ’s epigastric pain is arising from open sores in the upper region of the gastrointestinal track. The underlying issue is the destruction of the protective epithelial lining of the stomach and duodenum. One of the possible aetiopathological elements is the infection of Helicobacter pylori, a bacterium responsible for edematous development on the lining of the digestive track, the breakdown of the mucous, as well as increasing the level of acid. Similarly, over-the-counter NSAIDs could be contributing as the drugs alter the integrity of protective mucous layer. Lifestyle aspects such as smoking and alcoholism are also risk factors in the development of peptic ulcers.

What alterations would you suggest in his treatment?

One of the pre-treatment elements should be establishing the causal factor. In the event of H. pylori, the medication should be antibiotics and a prostaglandin analog. If the causal factor in not the bacterium, the focus should be stifling the production of digestive acid through proton pump inhibitor (PPI)–based triple therapy (Fontes, Martimbianco, Mochdece, & Riera, 2017). The prescribing doctor should also consider changing NSAIDS to Acetaminophen such as Tylenol, which does not irritate the GIT lining. The alteration is informed by the fact that stopping NSAIDS is not an option in TJ’s case because of their clinical relevance in managing osteoarthritis. Similarly, anti-secretory medications such as H2 blockers should be prescribed for at least one year as the recurrence suggests that TJ is a high-risk patient. The interventions should also be complemented by non-pharmacological approaches to help TJ quit smoking and reduce the use of alcohol.

References

Fontes, L. E. S., Martimbianco, A. L. C., Mochdece, C. C., & Riera, R. (2017). Proton pump inhibitor‐and fluoroquinolone‐based triple therapies for Helicobacter pylori eradication. The Cochrane Library.

Ghimire, P. G., Ghimire, P., Goel, R. G., & Bahl, D. V. (2015). The Spectrum of Changes in Gastric Mucosa with Helicobacter Pylori Infection. Journal of Nepalgunj Medical College, 12(1), 29-31.