NSG 6005 epigastric pain case: testing and prophylaxis
For TJ, a 55-year-old with two weeks of epigastric pain, a prior bleeding ulcer and ongoing OTC NSAID use, recommend additional testing, identify every variable contributing to his symptoms, and propose treatment changes including whether NSAID ulcer prophylaxis is warranted.
Editorial process
Last reviewed · August 13, 2026
Every detail in the vignette is a variable
The vignette is dense and every clause is there to be used. Two weeks of epigastric pain unrelieved by an over-the-counter H2 blocker, a documented bleeding ulcer a year ago, an incomplete course of therapy that almost certainly included Helicobacter pylori eradication, continuing OTC NSAID use for osteoarthritis, one to two packs of cigarettes a week, and daily alcohol. The second question asks for any and all variables, so the answer should be a systematic list rather than a headline: incomplete eradication leaving active infection, ongoing NSAID injury, alcohol and tobacco as mucosal irritants and healing impediments, inadequate acid suppression from an OTC agent, and the possibility that this is not ulcer disease at all. Normal vital signs and normal blood work do not exclude a recurrent ulcer; they make significant ongoing bleeding less likely, which is a different and much weaker claim than exclusion.
Testing should follow from those variables. Non-invasive H. pylori testing is the obvious first step given the incomplete course, with attention to the fact that recent acid suppression can produce false negatives. Endoscopy becomes the stronger choice given the prior bleed, the age, and symptoms that have not responded — and the alarm features worth naming explicitly. The treatment question then has three parts: escalate acid suppression appropriately, address the NSAID exposure by stopping, substituting or covering it, and treat any infection found with a regimen that accounts for local resistance. The prompt asks specifically about prophylaxis for NSAID-induced ulcers, so state who qualifies — prior ulcer or bleed, older age, concurrent agents — and what prophylaxis actually consists of. Support the answer with located guidelines and peer-reviewed articles in APA format, as the prompt requires — and note that only one of the two listed discussion questions is to be answered, so read the instruction before choosing which.
Likely learning objectives
Inferred from the brief — check these against your own rubric.
- 01Extract every clinically relevant variable from a dense vignette.
- 02Select diagnostic testing that follows from the identified variables.
- 03Explain why normal blood work does not exclude recurrent ulceration.
- 04Distinguish treatment of infection, acid suppression and NSAID exposure as separate actions.
- 05State the criteria for NSAID ulcer prophylaxis and what it consists of.
Read the full question
Review every instruction before using the planning guidance that follows.
Course-wide instructions that accompany this question
ADDITIONAL INSTRUCTIONS FOR THE CLASS Discussion Questions (DQ) Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. NSG 6005 Week 4 Assignment 1 DQ 2 One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses. Weekly Participation Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week. APA Format and Writing Quality Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition. Use of Direct Quotes I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source. LopesWrite Policy For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score. Late Policy The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading. Communication Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.
Turn the brief into deliverables
- 01Additional testing recommended at this point, with reasoning.
- 02A systematic list of all variables that could be contributing to the symptoms.
- 03Suggested alterations to his treatment.
- 04Consideration of additional diagnoses.
- 05An explicit judgement on whether NSAID-induced ulcer prophylaxis is appropriate.
- 06Support from located guidelines and peer-reviewed articles, cited in APA format.
Testing, variables, treatment, prophylaxis
What the vignette establishes
The history, the incomplete therapy, the exposures and what normal results do and do not exclude.
Additional testing
Non-invasive infection testing and the case for endoscopy given prior bleeding.
Contributing variables
Infection, NSAIDs, alcohol, tobacco, inadequate suppression and non-adherence.
Additional diagnoses
What else presents this way and how it would be distinguished.
Treatment alterations
Acid suppression, NSAID exposure and eradication treated as three separate actions.
NSAID ulcer prophylaxis
Who qualifies, on what criteria, and what prophylaxis consists of.
Guidelines, not general health pages
Recommended databases
- American College of Gastroenterology
- NIDDK
- StatPearls
- PubMed
- South University Online Library
Search sequence
- 1.Read a current peptic ulcer disease overview for aetiology and testing strategy.
- 2.Check the guidance on H. pylori test selection and the effect of recent acid suppression.
- 3.Read the NSAID pharmacology entry for gastrointestinal risk and prophylaxis criteria.
- 4.Identify the alarm features that would move a patient straight to endoscopy.
- 5.Locate a guideline you can cite for the prophylaxis recommendation.
Reference shortlist
These are authoritative starting points, not a ready-made bibliography. A qualified reviewer must confirm that each source fits the assignment and supports the claim beside which it is cited.
Nothing here is cleared for citation until you have read it.
- 01
Peptic Ulcer Disease
American College of Gastroenterology · 2025
The specialty society's account of causes, testing and management, which is the guideline the prompt asks for.
- 02
Peptic Ulcer Disease
StatPearls, NCBI Bookshelf · 2024
Differential diagnosis, testing strategy and the limits of laboratory findings.
- 03
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
StatPearls, NCBI Bookshelf · 2024
Mechanism of NSAID mucosal injury and the risk criteria that determine prophylaxis.
- 04
Peptic Ulcers (Stomach or Duodenal Ulcers)
National Institute of Diabetes and Digestive and Kidney Diseases · 2025
Diagnostic testing options and treatment principles from a federal institute.
Review before submission
Common mistakes
- Naming one cause when the question asks for any and all variables.
- Reading normal vital signs and bloods as ruling out an ulcer.
- Recommending H. pylori testing without noting that acid suppression causes false negatives.
- Escalating acid suppression while leaving the NSAID exposure unaddressed.
- Discussing prophylaxis without stating the risk criteria that would qualify him.
- Answering from general knowledge rather than located guidelines, which the prompt requires.
Submission checklist
- Testing recommendations are justified by specific vignette details.
- The variable list covers infection, NSAIDs, alcohol, tobacco and inadequate therapy.
- Alarm features and the case for endoscopy are addressed.
- Additional diagnoses beyond peptic ulcer disease are considered.
- Prophylaxis is answered with criteria and a named approach.
- Guidelines and peer-reviewed sources are cited in APA format.
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Written by
Aaron Bishop
MA, Education
assignment interpretation and research-methods coaching across disciplines
Aaron leads the EssayCrackers editorial desk. He works on how assignment briefs are read — what a rubric is actually asking for, and where students most often answer a different question than the one set.
Reviewed by
Dr. Nathan Cole
PhD, Rhetoric & Composition
Argumentation and thesis development
Nathan teaches first-year composition and directs a university writing center. He reviews EssayCrackers guides for argumentative soundness and citation accuracy.