A 56-year-old woman with a longstanding history of gastroesophageal reflux presents for follow-up evaluation of endoscopically confirmed gastric and duodenal ulcers. Her symptoms have been unresponsive to proton pump inhibitors and histamine receptor antagonists in the past. Results for H. pylori infection are still pending. Which of the following changes is expected in the patient's duodenum, given her peptic ulcer disease?
AProliferation of secretin-releasing S cells
BIncreased secretions from crypts of Lieberkühn
CIncreased glucose-dependent insulinotropic peptide (GIP) release from K cells
DExpansion of gastrointestinal lymphoid tissue
EHyperplasia of submucosal bicarbonate-secreting glands
A 30-year-old man who recently emigrated from Southeast Asia presents with heartburn and a bad taste in his mouth. He says the symptoms have been present for the last 6 months and are much worse at night. He describes the pain as moderate to severe, burning in character, and localized to the epigastric region. He mentions that 1 month ago, he was tested for Helicobacter pylori back in his country and completed a course of multiple antibiotics, but there has been no improvement in his symptoms. Which of the following is the most likely diagnosis in this patient?
APeptic ulcer disease
BGastric MALT (mucosa-associated lymphoid tissue) lymphoma
CDuodenal ulcer disease
DGastroesophageal reflux disease
EGastric adenocarcinoma
A 28-year-old graduate student visits the university health clinic for 3-weeks of epigastric pain that worsens with meals, associated with retrosternal pain, early satiety, and bloating. She denies vomiting blood or blood in her stool. She has been consuming large volumes of caffeinated-drinks and fast-food for a month, as she has been studying for her tests. Her family and personal history are unremarkable with no history of gastrointestinal cancer. Her vital signs are within normal limits. Physical examination is only positive for a mild epigastric tenderness. Which of the following is the most appropriate approach in this case?
ATreatment with metoclopramide
BUpper endoscopy
CFecal antigen testing for Helicobacter pylori
DTreatment with omeprazole
EBarium swallow radiograph
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