The importance of a patient’s background in formulating a management approach

Abstract

Peptic ulcer disease is uncommon in childhood, with non-specific clinical features. A tendency to late diagnosis makes it more likely for a patient to present with complications. Here we discuss a child with low socio-economic status from a developing country who presented with severe anemia secondary to a bleeding duodenal ulcer. The case highlights the importance of the patient’s background in the formulation of a management approach. In some cases this may be intuitive to an experienced physician. However, we demonstrate this with a simple mathematical diagnostic model using disease prevalences which are tied to our individual patient’s circumstances. The model shows how the negative predictive value of a test can change according to the patient’s background. We also suggest that the best treatment option will be influenced by the patient’s circumstances. Our patient comes from Nepal, but the principles involved are universally applicable.

Keywords

• Helicobacter pylori, negative predictive value, management approach