The gastroenterologist finds finds erosive esophagitis LA Class B, a moderately sized hiatal hernia, diffuse erosive gastritis, and an ulcer in the antrum of the stomach that is oozing blood. The duodenal buld yielded a nomal endoscopic appearance. During the EGD, the bleeding was stopped with cautery. Biopsies were obtained of the gastric mucosa, and the biopsies are negative for H. pylori bacteria; his bleeding ulcer is attributed to the NSAIDs (i.e., ibuprofen). He is kept NPO until the next morning to allow good hemostasis of the cauterized site. Clear liquids are allowed at breakfast. His hematocrit (Hct) dropped to 32% but he remained asymptomatic from the mild anemia; the drop was believed, in part, to reflect that he was dehydrated on admission, and the decrease reflected the dilution of the blood from the IV fluids added. Thus, he did not receive a transfusion of blood.
M.R. tolerated the liquid diet without any nausea and vomiting and is discharged to home the next day with the following instructions:
-Advance diet slowly, as tolerated, to mechanical soft.
-Take pantoprazole 40 mg PO q AM on an empty stomach, at least 30 minutes before eating
-Make a follow-up appointment in 6 to 8 weeks with physician (give name and telephone number).
-Stop all aspirin and over-the-counter (OTC) or herbal pain relief medications (ibuprofen,naproxen,etc.).
-Stop or limit alcohol intake and smoking.