A 32-year-old man was experiencing chronic severe pain extending from the right and left upper quadrants into the epigastric region and there was no evidence of internal bleeding. A history was taken.
He had been taking Zantac, Tagamet, and other ulcer-treating medications for the past three years. He was currently on Tagamet—two tablets 150 mg each, b.i.d. This level of medication was no longer effective. An endoscopy was scheduled and an emergency colonoscopy was performed. The fiberoptic colonoscope was introduced and was continued for almost 36 inches. No neoplasms were detected. The colonoscope was withdrawn.
A previous endoscopy, two years earlier, had shown no abnormal growths. A confirmatory barium swallow was conducted. No ulcers were detected. The original diagnosis of hiatal hernia was reconfirmed. He was also scheduled for a barium enema.
The patient prepared for the barium enema with a forty-eight hour solid food fast, with no liquids after the first twenty-four hours. He came into the lab in good spirits, despite the length of time without nourishment. He did not tolerate the procedure well, but the technicians were able to complete it in full.
The patient was advised to take the following steps: