Reflections about acid suppression therapy: choosing the optimal proton pump inhibitor, or the Captain’s Saga. Clinical case
Abstract
The author presented a clinical case of the combined course of gastric ulcer, gastroesophageal reflux disease against the background of significant increase in the fecal calprotectin level in the absence of endoscopic, histological confirmation of Crohn’s disease.Multiple erosive and ulcerative lesions of the upper gastrointestinal tract may result from various reasons, one of the possible explanations may be a common form of Crohn’s disease. A 32‑year‑old patient independently applied for a consultation with complaints of a «chill» in the throat, some heaviness in the stomach after eating. The endoscopic examination revealed signs of reflux esophagitis, multiple erosive and ulcerative lesions of the stomach and duodenum with negative urease test, as well as, presumably, healed solitary rectal ulcer. Gastrinoma and neuroendocrine tumor were excluded. A 10‑fold increase in the level of fecal calprotectin has been revealed. The results of histological examination of polypositional biopsies of the esophagus, stomach, duodenum, large intestine, rectum did not reveal signs of a tumor process, inflammatory bowel diseases. The erosive and ulcerative lesions of the upper parts of the digestive tube, not associated with Helicobacter pylori, cicatricial changes in the rectum have been found. Acid‑suppressive therapy with dexlansoprazole promoted the repair of the esophageal mucosa without a positive effect on the stomach. Replacement of the proton pump inhibitor and administration of…
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