Gastrointestinal System

{"ops":[{"insert":"Diagnosis and reasoning"},{"insert":"\n","attributes":{"header":1}},{"insert":"This patient has presented with recurrent symptoms of gastroesophageal reflux disease (GERD), along with a history of an endoscopically diagnosed duodenal ulcer.\n\nDespite being on optimal medical therapy for GERD, she has had little or no symptomatic relief. This may indicate either a persistent ulcer, or alternatively, a new gastrointestinal pathology.\n\nA repeat endoscopy is justifiable; this reveals that the ulcer yet exists. Given that over 90% of duodenal ulcers heal with 4 weeks of proton pump inhibitor therapy, this is distinctly unusual.\n\nFurthermore, the two key causes of duodenal ulceration (H. Pylori infection and NSAID usage) can also be ruled out here; neither are biopsies suggestive of a malignancy.\n\nAnother etiology of duodenal ulcers (particularly those which prove unresponsive to medical therapy) is Zollinger-Ellison syndrome, where a primary gastrinoma causes excessive hydrochloric acid production secondary to unregulated gastrin secretion. This is supported by the acc"}]}

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