Epigastric Abdominal Pain In Elite Soccer Player

Abstract

Epigastric Abdominal Pain in Elite Soccer Player Richard J. Edgar, MD Crozer Sports Medicine Springfield, PA Kevin DuPrey, DO (Crozer Sports Medicine Springfield, PA David Baxter, DO Crozer Sports Medicine Springfield, PA Thomas Kaminski, PhD, ATC, FACSM University of Delaware (Sponsor) HISTORY: A 24-year-old male professional soccer player presented with acute on chronic epigastric abdominal pain worsening over the last 2 weeks prior to presentation. Associated symptoms included nausea and sour taste in mouth. Denied constitutional symptoms, vomiting, jaundice, dysphagia, chronic cough, diarrhea, constipation, hematochezia, melena, and loss of appetite. He took NSAIDs for prior knee injury, but is unsure of which medication he has taken or the doses. He failed one prior trial of Ranitidine 150 mg BID, and two prior trials of Omeprazole 40 mg BID. Patient is from Africa with recent travel to Africa prior to presentation. PHYSICAL EXAMINATION: General: No acute distress.Eyes: PERRL, EOMI, conjunctiva normal, no icterusHENT: Normocephalic, atraumatic, no mouth ulcers, normal dentition. Cardiovascular: Regular rate and rhythm, no murmursLungs: Clear to auscultation bilaterally. Abdomen: Soft, non-distended, tenderness to palpation of epigastrium, bowel sounds present, no masses, no hepatosplenomegaly. DIFFERENTIAL DIAGNOSIS:1. Gastroesophageal Reflux Disease2. Peptic Ulcer Disease3. Helicobacter Pylori Infection4. Pancreatitis 5. Strongyloides stercoralis TEST AND RESULTS:Given the persistence of symptoms despite H2-blocker/PPI treatment, the patient underwent esophagogastroduodenoscopy (EGD) after cessation of H-2 blocker and PPI for 2 weeks. The EGD showed erosive gastropathy with no bleeding and no stigmata of recent bleeding. Biopsies taken during the EGD were consistent with Helicobacter Pylori infection. FINAL/WORKING DIAGNOSIS: Helicobacter Pylori Infection with Erosive Gastropathy TREATMENT AND OUTCOMES:The patient was treated with Clarithromycin triple therapy: Amoxicillin 1000 mg BID, Clarithromycin 500 mg BID, and Omeprazole 40 mg BID for 14 days. Patient had resolution of symptoms. He continued full sport participation throughout work-up and treatment.