ESOPHAGITIS,

CHRONIC GASTRITIS,
H.PYLORI INFECTION

By:
ODO, NOVIE A.
CELYON, JOSIE P.
INTRODUCTION

Patient T is a 52 years old,

female, who currently resides
at Greenfield,
Magpet North Cotabato. With
admitting diagnosis of Peptic
Ulcer Disease and a
final diagnosis of Esophagitis;
Chronic Gastritis; H.Pylori
infection.
 Esophagitis (uh-sof-uh-JIE-tis) is
inflammation that may damage tissues of
the esophagus, the muscular tube that
delivers food from your mouth to your
stomach. Esophagitis can cause painful,
difficult swallowing and chest pain.
Causes of esophagitis include stomach
acids backing up into the esophagus,
infection, oral medications and allergies.
 Chronic gastritis (CG) is the chronic
inflammation of gastric mucosa
associated with varying degrees of
damage of superficial and glandular
epithelia.
The causes of CG are exogenous
(mainly Helicobacter pylori) and
endogenous.
H. pylori was first discovered in
1981 by Barry Marshall and Robin
Warren.
 The prevalence of endoscopic
esophagitis in the U.S. is
approximately 7%. In
non-Western countries, the
prevalence of esophagitis seems to
be lower. It is
seen during endoscopic observation
in 1.5% to 5% of cases in China,
2.7% in
Korea, and 2% in Germany.
 In the Philippines,the incidence of
gastroesophageal reflux disease
diagnosed
through endoscopy has increased from
3-9% to 14-16% in the last decade. The
aim of this study was to determine
the prevalence of
erosive esophagitis (EE)
over a span of 10 years in a tertiary care
facility in the Philippines.
 Prevalence of chronic gastritis has
markedly declined in developed
populations during the past decades.
However, chronic gastritis is still one of the
most common serious pandemic infections
with such severe killing sequelae as
peptic ulcer or gastric cancer. Globally, on
average, even more than half of
people may have a chronic gastritis at
present.
 We, the BSN 4 choose this study
because it can help us to know and
understand the disease process and the
concept of Esophagitis, Chronic
Gastritis, and H.Pylori infection as well as to
gain knowledge and skills on how
to render best care to the patient.
OBJECTIVES
General Objectives
After 2 days of interaction with the
patient and completing the case study,
we the BSN 4 will be able to know and
understand the disease process and
the concept of Esophagitis, Chronic Gastritis,
and H.Pylori infection as
well as to gain knowledge and skills on how to
render best care to the patient.
Specific Objectives
Knowledge:
➢ To define Esophagitis, Chronic Gastritis,
and H.Pylori infection;
➢ discuss the anatomy and physiology of the
organ involve;
➢ trace the Pathophysiology of the condition;
➢ understand about the disease process: the
causes, effects, management,
treatment and possible preventions;
➢ to know and identify the drugs received by
the patient;
➢ determine why certain management and
medications are given and
provided for the condition; and
➢ formulate Nursing Care Plan related to the
case and determine the
possible intervention.
Skills:
➢ Perform efficiently physical assessment to
the patient;
➢ gather pertinent data regarding family
background and health history from
patient and significant others;
➢ participate in the course of care of patient;
and
➢ Promote health teaching and interventions
to the family and significant
others.
Attitude:
➢ Establish a good interpersonal relationship
to the client and his family; and
➢ provide the patient and family with proper
discharge planning.
III. PATIENT’S DEMOGRAPHIC DATA
Patient’s Code Name: Patient T.
Age: 52 years old
Birthday: October 23, 1966
Birthplace: Greenfield, Magpet North Cotabato
Sex: Female
Status: Married
Religion: Roman Catholic
Nationality: Filipino
Address: Greenfield, Magpet North Cotabato
Educational Attainment: College level
Occupation: At Water refilling station
Date of Admission: July 15, 2019 – 5:00pm
Physician: Dr. Vargas
Station/Room: NS1-107
Admitting Diagnosis: Peptic Ulcer Disease
Final Diagnosis: Esophagitis, Chronic
Gastritis, and H.Pylori infection
HEALTH HISTORY
a. Family Socio-Economic Background
Patient T is a 52 years old, female,
currently resides at Greenfield,
Magpet North Cotabato, Filipino citizen.
Married to Mr T and blessed with
5 children; 5 boys. Her husband has a history
of stroke and has been
suffering with diabetes for 3 years. Since then,
Patient T is the one who
provides the needs of her family. All of her
children are healthy except for
her youngest who has Autism Disorder.
 According to Patient T, when she got
married to Mr T, they manage a 2
hectares of rubber plantation that can earn a
minimum of 2,000 pesos in
15 days. But when her husband got stroke
she tend to do it herself.
Patient T is currently working at a Water
Refilling Station for 2 years
with a minimum wage of 200 pesos in a day.
Her first child, 27 years old,
is studying at USM-KCC taking Bachelor of
Science in Information
Technology, a scholar and with an allowance
of 5,000pesos in a month.
 Her second child, 25 years old, is a
graduate of Bachelor of Elementary
Education at CFCST-Doroloman Arakan and
currently working as a clerk
at Municipality of Arakan. Her third, 23 years
old, child is still studying at
USM-KCC taking Bachelor of Elementary
Education, a scholar and with
an allowance of 5,000 pesos in a month. Her
fourth child, 22 years old, is
a graduate of Bachelor of Science in Forestry
and do part time job while
her youngest is a 12 years old boy with Autism
Disorder.
 Her usual diet is composed of 2 cup rice
with a viand of vegetables,
dried fish in a combination of a cup of coffee
in every meal. She
sometimes skips meal when she already drink
coffee. As stated by Patient
T she didn’t smoke nor drink alcoholic
beverages.
History of Past Illnesses
According to Patient T, when she was
younger she experienced
chickenpox and measles but she cannot
remember her age. her fist admission was on
2006 at Kidapawan Medical Specialist
Incorporated
with a chief complain of stomach ache and
diagnosed with Hyperacidity,
and her second admission was on 2016 at
Kidapawan Medical Specialist
Incorporated again but it is due to her
pregnancy.
History of Present Illnesses
According to patient T, 3 days prior to
admission she experiences
epigastric pain with nausea and vomiting.
Then, she decided to send
herself at Madonna Medical Center
Incorporated on July 15, 2019.
With the following vital signs of:
Blood pressure: 120/90mmHg
Respiratory rate: 21cpm
Pulse rate: 67 bpm
Temperature: 36.2ºC
GENOGRAM
DEVELOPMENTAL DATA
DEFINITION OF COMPLETE DIAGNOSIS

Esophagitis (British
spelling oesophagitis) is a disease
characterized by inflammation of
the esophagus.
The esophagus is a tube composed of
a mucosal lining, and longitudinal and
circular smooth muscle fibers. It connects
the pharynx to the stomach; swallowed
food and liquids normally pass through it.
 Esophagitis can be asymptomatic; or can
cause epigastric and/or substernal
burning pain, especially when lying down or
straining; and can make swallowing
difficult (dysphagia). The most common cause
of esophagitis is the reverse flow
of acid from the stomach into the lower
esophagus: gastroesophageal reflux
disease (GERD).
Types
1. Reflux esophagitis
For decades it has been assumed that
inflammation from acid reflux was caused
by the irritation of acid itself. A recent study, however,
points toward a cause and
effect relationship that is less clear, and
demonstrated that inflammation may not
be caused by acid reflux, but that both reflux and
inflammation could be caused
by an underlying third factor. It is a common
misconception that reflux has been
proven to cause inflammation in the esophagus.
2 Infectious esophagitis
Esophagitis that happens due to a viral,
fungal, parasitic or bacterial infection.
More likely to happen to people who have an
immunodeficiency. Types include:
Fungal: Candida (Esophageal candidiasis)
Viral: Herpes simplex (Herpes esophagitis);
Cytomegalovirus
3 Drug-induced esophagitis
Damage to the esophagus due to
medications. If the esophagus is not coated or
if the medicine is not taken with enough liquid,
it can damage the tissues.
4 Eosinophilic esophagitis
This esophagitis is caused by a high
concentration of eosinophils in the
esophagus. The presence of eosinophils in the
esophagus may be due to an
allergen, and is often correlated with GERD. The
direction of cause and effect
between inflammation and acid reflux is poorly
established, with recent studies
(in 2016) hinting that reflux does not cause
inflammation. This esophagitis can be
triggered by allergies to food or to inhaled allergens.
This type is still poorly
understood.
5 Lymphocytic esophagitis
Lymphocytic esophagitis is a rare and
poorly understood entity associated with
an increased amount of lymphocytes in the
lining of the esophagus. It was first
described in 2006. Disease associations may
include Crohn’s
disease, gastroesophageal reflux
disease and celiac disease. It causes similar
changes on endoscopy as eosinophilic
esophagitis including esophageal rings,
narrow-lumen esophagus, and linear furrows.
6 Caustic esophagitis
Caustic esophagitis is the damage of
tissue via chemical origin. This occasionally
occurs through occupational exposure (via
breathing of fumes that mix into the
saliva which is then swallowed) or
through pica. It occurred in some teenagers
during the fad of intentionally eating Tide pod
 Chronic gastritis (CG) is the chronic
inflammation of gastric mucosa
associated with varying degrees of damage of
superficial and glandular epithelia.
The causes of CG are exogenous (mainly
Helicobacter pylori) and endogenous.
The process is concluded by atrophy of
parenchyma. CG is associated with
dyspepsia in approximately 50% of cases, but
frequently with gastric and
duodenal ulcer. The role of chronic atrophic
gastritis (AG) is relevant in
development of cancer or of other tumors like
carcinoids and polyps.
ANATOMY AND
PHYSIOLOGY
Digestive System Organs
The easiest way to understand the
digestive system is to divide its organs into
two main categories. The first group is the
organs that make up the alimentary
canal. Accessory digestive organs comprise
the second group and are critical for
orchestrating the breakdown of food and the
assimilation of its nutrients into the
body. Accessory digestive organs, despite
their name, are critical to the function
of the digestive system.
PHYSICAL ASSESSMENT – July 17, 2017
A. Review of Systems –verbatim-
1. General Overall Health State
“Maam, ga wala wala man sakit sa akoa tiyan
dili na pareha atong first na admit ko
gahapon”
2. Integument (Skin, Hair, Nails)
“wala man koy mga katol2 sa panit maam”
3. Head
“wala man ga sakit akoa ulo maam, wala man
pod mga bukol2”
4. Eyes
“okay paman akoa panan.aw maam”
5. Ears
“okay aman akoa pandungog maam,
makadungog paman kog tarong”
6. Nose and Sinuses
“wala man ko nagkalisod ug ginhawa maam”
7. Mouth and Oropharynx
“dili man sakit kung magtulon ko maam”
8. Thorax and Lungs
“wala man ko ginaubo maam”
9. Heart and Central Vessels
“wala man ko ginakulbaan maam”
10.Peripheral Vascular System
“wala man koy mga varicose maam”
11. Breast and Axillae
“wala may mga bukol akoa totoy maam”
12. Abdomen
“ga wala2 man ng sakit sa akoa tiyan”
13. Musculoskeletal System
“wala man ga sakit  akoa kasukasuhan
maam”
14. Neurological System
“makalimot-limot nako maam uy siguro sa
katigulangon nako”
15. Genitals and Inguinal Area
“makaihi man ko maam, wala man sakit”
16. Rectum and Anus
“makatae man ko na walay sakit maam”
 Cephalocaudal Physical Assessment
General Appearance and Mental Status
Received patient sitting on bed, awake,
conscious and responsive to questions ask. Wearing
white shirt with gray leggings without IVF. Both
toenails and fingernails were untrimmed.
Vital Signs/Measurements
Blood Pressure: 110/80mmHg               O2 sat: 99%
Respiratory rate: 20cpm
Pulse rate: 75bpm
Temperature: 36.5ºC
Integument
Patient has wrinkled skin due to aging. Fair
complexion with slightly dry skin indicating poor
skin turgor. Hair is short, grayish in color with no
presence of dandruff, nits and lice.
Head
Head is normocephallic upon palpation. Face is
symmetrical upon inspection. Able to move head
side to side without pain and difficulty.
Eye Structures and Visual Acuity
Evenly placed and in line with each other. None
protruding. Conjunctiva is pinkish to red in color.
Pupil are equally round and reactive to light
accommodation with a size of 3mm. Able to see
near and far objects. 
Ears and Hearing
The auricles are parallel in shape. The upper
connection of the earlobe is parallel with the
outer canthus of the eye. Presence of cerumen
not noted. Able to hear both left and right ear.
Nose and Sinuses
Nose is in the midline. Flaring of nostril not noted.
Respiratory rate of 20 cycles per minute. No
inflammation of the sinuses noted upon
palpation.
Mouth and Oropharynx
Lips is dry. Able to chew and speak. Gums are
pinkish in color. With no dental carries noted.
Neck
Neck is straight and symmetrical, no visible mass or lumps
noted upon palpation. No jugular venous distention
noted.
Thorax and Lungs
Chest contour of client is symmetrical during respiration and
in typical size. No crackles sound noted upon
auscultation. Respiratory rate of 20 cycles per minute.
Peripheral Vascular System
No varicosities noted.
Breast and Axillae
No lumps noted upon palpation. No abnormal discharges
noted.
Abdomen
Upon auscultation borborygmi sounds noted with a range of
30-35 in one minute. With minimal pain noted upon
palpation.
Musculoskeletal System
Able to do range of motion with no pain noted.
Can move both arms and feet.
Neurological System
Unable to recall things that are so long ago.
Genitals and Inguinal Area
Able to void 5 times a day with no signs of
pain and difficulty.
Rectum and Anus
Able to defecate 2 times a day without
complain of pain.
Upper and Lower Extremities
Able to do range of motion both arms and
legs, and can perform activity of daily
living.
ETIOLOGY AND SYMPTOMATOLOGY

PATHOPHYSIOLOGY
MEDICAL MANAGEMENT
A. Doctors Order
B. Diagnostic Examinations
DRUG STUDIES
NURSING THEORIES
Betty Neuman
The System Model, developed by Neuman, focuses
on the response of the client system to actual or
potential environmental stressors and the use of
several levels of nursing prevention intervention
for attaining, retaining and maintaining optimal
client system wellness. Neuman defines the
concern of nursing is preventing stress invasion.
If stress is not prevented, then the nurse should
protect the client's basic structure and obtain or
maintain a maximum level of wellness. Nurses
provide care through 
primary, secondary and tertiary prevention
modes.For us nurses we need to maintain the
optimal level of wellness of our patient in order
not to have further complication. And as Patient
T’s response she is willing to apply the health
teaching that we provided
 Hildegard Peplau
Four phases define Peplau's Interpersonal
Theory or nursing. She defines the nurse/patient
relationship evolving through orientation,
identification, exploitation and resolution. She
views nursing as a maturing force that is realized
as the personality develops through educational,
therapeutic, and interpersonal processes.
Nurses enter into a personal relationship with an
individual when a felt need is present. Peplau's
model is still very popular with clinicians working
with individuals who have psychological
problems.For us student nurses we need to
established rapport to gain the trust of the
patient to be able to come with a good nursing
intervention.
 Virginia Henderson
Often called "the Nightingale of Modern
Nursing," Henderson was a noted nursing
educator and author. Her "Need Theory"
was based in practice and her education.
She emphasized the importance of
increasing a client's independence to
promote their continued healing progress
after hospitalization. Her definition of
nursing was one of the first to mark the
difference between nursing and medicine.
NURSING CARE PLAN
LEVELS OF PREVENTION
Primary
 It includes food that should be avoided and can
cause gastritis such as high in acidic foods.

Secondary
When signs and symptoms of chronic gastritis you
should have a check-up at a nearest hospital
and should have a laboratory test called H.pylori
because it is the one that causes gastritis.

Tertiary
Should have a proper discharge planning.
DISCHARGE PLAN (METHOD)
Medication:
Instruct the patient to take the medicines on
time that has been prescribed by the
physician.
Home meds:
Clarithromycin 500mg/tab, 1tab BID for 2
weeks
Amoxicillin 500mg/capsule TID for 2 weeks
Omeprazole 40mg/capsule, 1capsule OD for 2
weeks
Exercise:
Encouraged to avoid strenuous activities
Encouraged to do range of motion.

Health Teaching:
Instructed and explained to the patient and
significant other’s the importance of
compliance in treatment regimen.
Instructed patient to send for medical
management if unusualities occur
Instructed to have proper hygiene
Eat nutritious foods such as fruits and
vegetables
Out Patient Follow-up
Advised patient and significant others to have
a follow up check as ordered by the
physician
.
Diet
Diet as tolerated
Increase oral fluid intake
Prognosis

Result:  Good 
Because the patient sent herself to seek
medical attention as soon as she felt the
signs and symptoms. She is willing to
undergone any medical treatment and
nursing intervention.
EVALUATION
General Objectives
After 2 days of interaction with the patient and
completing the case study, we the BSN 4
was able to know and understand the
disease process and the concept of
Esophagitis, Chronic Gastritis, and
H.Pylori infection as well as to gain
knowledge and skills on how to render
best care to the patient.
Specific Objectives
Knowledge:
defined Esophagitis, Chronic Gastritis, and
H.Pylori infection;
discussed the anatomy and physiology of the
organ involve;
traced the Pathophysiology of the condition;
understands about the disease process: the
causes, effects, management, treatment
and possible preventions;
knows and identify the drugs received by the
patient;
determined why certain management and
medications are given and provided for the
condition; and
formulated Nursing Care Plan related to the
case and determine the possible
intervention.

Skills:
Performed efficiently physical assessment to
the patient;
gathered pertinent data regarding family
background and health history from patient
and significant others;
participated in the course of care of patient;
and
Promoted health teaching and interventions to
the family and significant others.

Attitude:
Established a good interpersonal relationship
to the client and his family; and
provided the patient and family with proper
discharge planning.
RECOMMENDATIONS

To the patient:
Adhered therapeutic plan by the doctor.
Advise the patient to have a regular check-up.
To the family:
Assist client in her activity.
Should actively participate in providing, promoting,
assisting the client to perform health activities.
Should be knowledgeable of the signs and
symptoms of complication to be reported.
Should understand the importance of follow up
check-up for the monitoring of complications.
To the Madonna Medical Center
Incorporated:
Should have appropriate knowledge in caring
patient with Esophagitis, Chronic
Gastritis, and H.Pylori infection
Should be concern to every patient and give
their tender loving care to them
Must give proper health education especially
on ways how to prevention of the disease
and its complications.
To the Paramedical students:
Should provide appropriate health teaching to
every individual regarding the signs and
symptom and complications of the disease
as well as on how to prevent acquiring
such disease.
Should act as an advocate in how to avoid in
acquiring Esophagitis, Chronic Gastritis,
and H.Pylori infection to every individual
in a certain community