Stomach/Duodenum
23 cases spanning H. pylori eradication and acid-suppression strategy, gastroparesis and functional dyspepsia, stress-ulcer and NSAID-gastropathy prophylaxis, and rarer motility and mucosal disorders — choose a case below to open its full multi-voice debate.
A single patient with a fresh H. pylori diagnosis and no resistance test in hand. The disagreement isn't about which regimen works — both do — it's about how much weight one prior antibiotic course should carry when the alternative to guessing right is a guideline-standard regimen built specifically not to need the guess at all.
A single patient, two hours past endoscopic control of a high-risk bleeding ulcer. The disagreement is between the drug with the sharper mechanism and the drug with the trial actually built for this exact window.
A single patient whose safer prokinetic option is disappearing from the U.S. market while her doctors are still deciding whether to prescribe it. The disagreement isn't about which drug fits her — it's about how to plan around one that might not be there much longer.
A single patient whose prokinetic stopped working the same way it started — not because his disease changed, but because the drug's own mechanism predicted this. The disagreement is about how much to ask of a 66-year-old managing an irregular dosing schedule alone.
A single patient on a decade-old prescription nobody ever re-examined. The disagreement isn't about whether to eventually stop it — both agree on that — it's about whether the symptoms that show up during the taper mean anything at all.
A single patient three days into dual antiplatelet therapy with an ulcer history nobody wants to reawaken. The disagreement starts as a label-versus-trial argument and ends as a question of which PPI avoids the argument entirely.
A single patient with three weeks of new dyspepsia and no worrisome features. The disagreement is between the strategy that answers the question and the strategy that relieves the symptom fastest — and whether both can happen at once.
A single patient with a diagnosis that has three reasonable first-line drugs and no reliable way to predict which one she'll respond to. The disagreement is about whether her specific subtype is a real tiebreaker or a theory not worth privileging over simple risk-based sequencing.
A single patient whose acid suppression has quietly stopped holding, years into a genetic disease that keeps producing more of the hormone driving it. The disagreement is about whether this is a dosing problem that can still be pushed further, or a disease problem that needs a different drug entirely.
A single patient with a genuine cancer diagnosis whose first treatment is an antibiotic, not an oncologic regimen. The disagreement isn't about that first step — it's about how long to let an indolent disease's own slow biology play out before treating a delay as a failure.
A single patient with a textbook diagnosis and an old teaching about its treatment that the actual absorption physiology no longer fully supports. The disagreement is about whether her existing neurologic symptoms change what counts as an adequate substitute for the shortcut oral therapy usually offers.
A single patient on a prophylactic drug order that has run four days without anyone asking whether it still needs to be there. The disagreement is really about what a ventilated patient's risk profile has to include before continuing therapy is worth choosing all over again.
A single patient whose reflux, confirmed on formal testing, simply hasn't responded to a maximized standard regimen. The disagreement is between the drug matched to her actual test result and the drug better matched to her job.
A single patient treated for over a year for a diagnosis that may have never been the right one. The disagreement isn't between two drugs at all — it's about whether continuing to prescribe for the wrong mechanism can ever be the safer choice.
A single patient whose family history quietly reframes which drug family her prophylaxis should come from. The disagreement is about how much weight a real but circumstantial history should carry against a drug's own disease-specific track record.
A single patient whose two organ systems are each arguing for a different anti-inflammatory choice. The disagreement is between the drug matched to his best-documented risk and the drug matched to his most recent one.
A single patient whose chronic anemia has already been traced to the right disease, just not yet to the right treatment plan. The disagreement is about how to start a first-ever drug safely, not about whether it belongs in his regimen.
A single patient managing two mechanistically unrelated symptom clusters that happen to share the same surgical cause. The disagreement is between the drug that treats the more dangerous problem and the drug that treats both.
A single patient whose bleeding source has no strong medical treatment behind it at all. The disagreement is honestly about whether a weak option is still worth trying when nothing stronger exists.
A single patient recently diagnosed with a disease still being defined by the same research that's now offering it a new treatment. The disagreement is between the more established option and the one that might spare him decades of a cycle the established option all but guarantees.
A single patient whose first treatment failed in a way that changes what the second one should even attempt. The disagreement is about which of two remaining unknowns is the safer one to bet against.
A single patient whose treatment protocol has outlived the evidence it was built on by over a decade. The disagreement is less about him specifically than about how long a superseded assumption can keep running as a standing order before someone asks why.
A single patient on a drug that has outlasted its own warning label's assumptions, with no working alternative in sight. The disagreement isn't resolved by the end of the visit — it's named honestly instead, because pretending otherwise would be dishonest about what's actually known. ---