Rationale:
There is very strong rationale for Gastritis as a differential diagnosis, as nearly all of symptoms the patient is presenting with match the clinical picture seen with inflammation of the gastrointestinal lining. Patients with Gastritis commonly present with previous H. Pylori exposure, use of NSAIDs, epigastric tenderness, alcohol use, anorexia due to a vague feeling of fullness with meals, and non-specific symptoms such as nausea and vomiting (McCance & Huether, 2019). All of these symptoms match the clinical picture of the 65 y.o. presenting female, making Gastritis a viable possibility as a diagnosis for her.
It makes sense that Gastritis and Peptic Ulcer disease have almost identical clinical presentations, as they have a very similar etiology. Both involve damage to the mucosal barrier of the gastrointestinal lining that is typically preceded by an H. Pylori infection, and therefore both disease processes are commonly exacerbated by use of NSAIDS or caffeine and alleviated by antacids (McCance & Huether, 2019). Both can also be influenced by psychologic stress, which could be a big factor with this patient, as she raised two kids as a single parent. However, the two disease processes are ultimately different in that Peptic Ulcer disease involves significant erosion or break in the mucosal lining (sometimes extending as far as the vasculature and causing bleeding), while Gastritis is usually an inflammation of the lining without breakage (pictured in Figure 5). These differences are pictured in Figures 4 and 5 below:
Figure 4. Peptic Ulcer (VS Hospitals, 2018)
Figure 5. Endoscopy of normal gastrointestinal lumin compared with inflamed stomach wall (ePain Assist, 2019)
The patient’s history of Acute Pancreatitis, as well as her age being over 65, both indicate the possibility that her diagnosis is Peptic Ulcer disease over Gastritis. Additionally, Acute Gastritis often resolves spontaneously in a few days, and her abdominal discomfort has been going on for 2 months. Chronic gastritis often occurs with other autoimmune diseases such as rheumatoid arthritis, and patients sometimes start to see mucosal atrophy which can lead to pernicious anemia, as gut is atrophied and unable to absorb vitamin B12 (McCance & Huether, 2019). If she had Gastritis, she would likely present with more of these symptoms or maybe a history of autoimmune disease, which aren’t included in her clinical picture. This would be a consideration, but probably not definitive.
Given the similarities in presentation between Gastritis and Peptic Ulcer disease, it may be necessary for an endoscopy to be completed to confirm whether an ulcer has formed. The pictures below show endoscopies of an ulcer (Figure 6) and inflammation with no ulcer formation (Figure 7). Her provider may decide to order an endoscopy to confirm her diagnosis definitively.
Figure 6. Endoscopy reveals ulceration of stomach lining (Meddiction, 2016)
Figure 7. Endoscopy of normal antrum compared with endoscopy of inflamed stomach lining (Pathogenesis of Diseases of the Stomach, 2008)