Step 2

Gastrointestinal 5

A 48-year-old woman presents to the emergency department complaining of occasional sharp epigastric pain for the past month and an episode of hematemesis this past week. The patient reported 6 months ago having a similar pain and received a 4-week course of esomeprazole which relieved her discomfort. She reports feeling nauseated this past week and has noted “coffee ground” emesis mixed with food content and saliva when she vomited. She denies fever, chills, chest pain, palpitations, cough, wheezing, hematuria, hematochezia, and melena. She denies being on any other medications including non-steroidal anti-inflammatory drugs (NSAIDs). She recently immigrated from Cambodia. Vital signs are blood pressure is 118/63 mmHg, heart rate 98 beats/minute, respirations 20/minute, oxygen saturation 96% on room air, and she is afebrile. On physical examination, her conjunctivas are somewhat pale, and the remainder of the examination is unremarkable. Laboratory findings show WBC 13/mm3, hemoglobin 10.8 g/dL with an MCV of 77, platelets 210,000/mm3, BUN 38 mg/dL and creatinine 1.2 mg/dL. The patient undergoes esophagogastroduodenoscopy (EGD) which shows a non-bleeding gastric ulcer without visible vessels, mild gastritis, and a hiatal hernia. Her gastric ulcer biopsy is sent for culture and pathology with results pending. Campylobacter-like organism (CLO) testing performed on her biopsy specimen during her EGD is positive. She is currently receiving intravenous pantoprazole twice daily and intravenous fluids.

Which of the following is the most appropriate therapy given the results of the CLO test?

  • A) Consult nephrology for acute renal failure
  • B) Start octreotide drip
  • C) Start on oral proton pump inhibitor, clarithromycin, and amoxicillin
  • D) Switch pantoprazole intravenously twice daily to famotidine intravenously twice daily
  • E) Transfuse 2 units of packed red blood cells


Yunjia Shen


Dr. Raj Dasgupta