A 55-Year-Old Man Comes to the Office Due to Intermittent

question 63

Multiple Choice

A 55-year-old man comes to the office due to intermittent abdominal pain.  He has no difficulty or pain with swallowing.  The patient occasionally uses over-the-counter pain medicine for osteoarthritis of the right knee.  He does not use alcohol or tobacco and has no history of cancer in the family.  He works as an air traffic controller at a busy airport.  Upper gastrointestinal endoscopy shows an ulcer in the distal duodenum.  Fasting serum gastrin concentration is at the upper limit of normal and rises in response to intravenous secretin.  This patient's condition is most likely caused by which of the following processes?

• A)Autoimmune destruction
• B)Helicobacter pylori infection
• C)Mucosal immune dysregulation
• D)Neoplasm
• E)Nonsteroidal anti-inflammatory drug use
• F)Stress

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