Dr Abhishek M Sutrave
Abstract
This case report describes erosive pangastritis with a superimposed diminutive fundal polyp and a small hiatus hernia, along with Helicobacter pylori infection. A 35-year-old male presented with a constellation of symptoms, including abdominal bloating, epigastric pain, increased appetite, hunger headaches, and bilious vomiting, along with a concurrent sensation of rectal burning. The patient had been undergoing conventional treatment with proton pump inhibitors twice a day. Endoscopic evaluation revealed a positive Rapid Urease Test (RUT), confirming Helicobacter pylori infection, as well as a small hiatus hernia, diminutive fundal polyp, and erosive pangastritis. Skin eruptions that had occurred in the past reappeared after two and a half months of homeopathic treatment, illustrating Hering’s Law of Cure. Holistic homeopathic treatment led to a remarkable improvement in the patient’s quality of life, marked by the relief of all symptoms, ultimately resulting in the discontinuation of conventional medications, including homeopathy, within a timeframe of 6 months, with no recurrence observed during the subsequent 6 months of follow-up.
Introduction
Erosive pan gastritis is a medical condition characterised by inflammation and erosion of entire stomach lining, involving both the antrum and fundus of the stomach. This is a more severe form of gastritis diagnosed through endoscopy. Common cause of gastritis includes Helicobacter pylori (H. Pylori) infection, Prolonged use of NSAIDs, Alcohol abuse, stress trauma and autoimmune conditions. H. Pylori infection affects around 50% of the population world-wide with higher prevalence in developing countries. Majority of patients with H. Pylori infection remain asymptomatic, if symptoms are present, usually abdominal pain, nausea, vomiting or dyspepsia. But not everyone who is exposed to H. pylori will develop infection and the reason why some individuals become infected while others don’t is still unknown. Erosive gastritis is classified in ICD-10 diagnostic manual under the code 2023 ICD-10-CM Diagnosis Code K29.60
The urease activity of H. pylori plays an important role in countering the acidic environment of the stomach. The flagella-mediated motility helps H. pylori bacterium move towards the host gastric epithelial cells, followed by the bacterial adhesins interacting with the host cell receptors, leading to successful colonization and persistent infection. There are many effector proteins/toxins that are released by H. pylori that lead to host tissue damage. Both acute and chronic inflammation is seen in H. pylori gastritis as eosinophils, neutrophils, mast cells, and dendritic cells are stimulated. The gastric epithelial layer also secretes chemokines to initiate innate immunity and activates neutrophils that further damages the host tissue leading to the formation of gastritis. H. Pylori infection can lead to pangastritis and can increase the risk of hiatus hernia due to inflammation and irritation of stomach lining have weakened the LES over time.
Long-term Proton pump inhibitor (PPI) use can promote development of fundal gland polyp in the stomach because the decrease in stomach acidity leads to increased production of gastrin. Gastrin has trophic effects that lead to parietal cell and enterochromaffin-like cell hyperplasia and the formation of fundic gland polyps (FGPs) are seen. This case presented endoscopy findings are diminutive fundal polyp i.e., >5 mm.
Case report
- Name- Mr. A
- Age- 35 yr.
- Sex- Male
- Occupation – Bank employee
- Marital status- married
- Religion- Hindu
- Address-
- Date- 22.9.22
Presenting Complaint
C/o epigastric pain, increased appetite, rectal burning, bilious vomiting, hunger headache since 6 months.
History Of Presenting Complaints
Patient was apparently well 6 months ago. The started the pain in the epigastric region with increased appetite and was taking Proton pump inhibitors twice a day for 6 months with not much amelioration of symptoms. Then consulted the doctor and advised to go through endoscopy.
| Location | sensation | Modalitiy | concomitant |
| 1. Abdomen- epigastric and stomach | pain | <hunger during, midnight after
>eating, eructation |
Appetite increased. |
| 2. Rectum | burning | <during stools | |
| 3. Head | Pain | <hunger
>vomiting > eating |
Bilious Vomiting |
Past History
- Inguinal eruption from age of 20 -24 (Rx conventional medicine with external application)
- Recurrent mouth ulcer during exams from 10-23 years of age.
Family History
Father- lung CA
Mother – apparently healthy.
Elder Sister- Allergic tendencies.
Personal History
- Diet- Mixed
- Appetite- increased since 6 months
- Hunger – increased since 6 months
- Thirst – Thirsty+
- Desire- Sour fruits since childhood
- Aversion – Nothing specific (N.S)
- Urine- 3-4 times / day, no burning & itching
- Bowel movement – once a day with no associated complaints.
- Perspiration – generalised
- Sleep –good
- Dreams – N.S
- Thermals – chilly patient +
Life Space Investigation
Patient was introvert since childhood. Had few friends because he could not go and talk to new people, and the reason for not being able to make new friends or talk to people would be he was not courageous enough. He had tremendous anticipatory fear before exams since his childhood, was not able to sleep the day before, but the performance in the exams would be quite good. He always developed mouth ulcer before exams. Never was confident enough to go on stage on talk. He knows he has the capability to take up the task and perform, he knows he has experience but he is not confident enough and ends up not taking up the task. He is fast in learning new things. He was finally got a job as assistant manager in a bank. Right before patient developed Gastric disturbances there was an accountancy issue in the office, and a notice was sent to him to acknowledge and address the issue, he was summoned by higher authority to give an explanation about the situation. Patient was so stressed out about this, he was not able to approach the higher authority even though he was summoned to do so, had lost confidence in his job which he had been doing since almost 4 years. He ended up and trying to solve it although it was a small issue, he feels he can solve it but had no confidence to go and approach superiors and talk it out. Whenever he is tensed about any situation he tends to eat a lot sometimes with hunger and sometimes without hunger and he feels better.
General Physical Examination And Vitals
- Conscious & oriented with time, place and person.
- No edema, clubbing, cyanosis, icterus, pallor
- BP- 110/70mm Hg
- PR – 76 beats/ min
- Temp – afebrile at the time of examination
Systemic Examination
- Respiratory system -B/L normal vesicular breathing sounds, heard No added sounds
- Cardiac system – S1 & S2 heard, no murmur heard.
- Gastrointestinal system
Inspection: no scar, no lump, no visible pulsation
Palpation: no tenderness
Percussion: tympanic note heard
Auscultation: 3 to 5 bowel sounds heard per minute
Laboratory Investigation & Findings
- Endoscopy done on September 2022 –
Erosive pangastritis
RUT positive
Small hiatus hernia
Diminutive fundal polyp
