C A S E F IL E Bacteria Cause That? I was working in an endoscopy unit as a registered nurse when I met Natasha, a 20-year-old college

Bacteria Cause That?
I was working in an endoscopy unit as a registered nurse when I met Natasha, a 20-year-old college student. Natasha was having a gastroscopy to determine the cause of her persistent stomach pain.
Natasha had been having episodes of epigastricpain intermittently for 5 years. Approximately every 4 to 6 weeks, she would experience intense upper abdominal pain that left her unable to engage in her usual activities, including her classes and work. She would experience what she described as intense hunger, but pain would worsen immediately after eating so she learned to avoid eating during the worst of her “attacks,” which could last as long as 5 days.
She had been admitted to the emergency room after a particularly intense bout of pain. She was dehydrated and weak and her pain was constant. Lab studies revealed an elevated hemoglobin level, indicative of dehydration, and a normal white blood cell count. She had no fever. Her epigastric area was moderately tender on palpation. Her heart rate was elevated, likely as a response to the pain she was experiencing. The ER physician who examined her had admitted her to the hospital and arranged an urgent gastroscopy.
Once in the endoscopy unit, Natasha was given medications to induceconscious sedation. The back of her throat was anesthetized and the gastroscopy scope was passed down her throat. The esophagus was visualized as normal. The stomach, however, was inflamed, with evidence of prior healed ulcerations. One small unhealed lesion remained.
Just as the ER physician had expected, Natasha had a gastric ulcer. Biopsiesof the inflamed area were obtained, as well as photographs of the lesion, and the scope was removed. Natasha was then given medication to reverse the effects of the sedatives. Once fully recovered, Natasha was released to go home.
A week later, Natasha had an appointment with the gastroenterologist, who told Natasha that biopsies had revealed the presence of Helicobacter pylori in her stomach, which had caused the ulcers. She was prescribed a combination of antibiotics and an acid reducer and was given an appointment to follow up after she had completed the therapy to confirm the efficacy of the treatment. She was also instructed to contact them again if she experienced any more episodes of stomach pain.
• How does H. pylori survive in the acidic environment of the stomach?
• What classic response to injury did Natasha display?

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