A 62-Year-Old Man Is Being Evaluated for a 6-Month History

question 300

Multiple Choice

A 62-year-old man is being evaluated for a 6-month history of occasional epigastric pain that is relieved by eating.  The patient has tried over-the-counter antacids and ranitidine with some relief.  He has had no dysphagia, weight loss, black stools, or blood in the stool.  The patient has a 15-pack-year smoking history and drinks alcohol socially.  He immigrated to the United States from China at age 12 with his family.  He had a normal screening colonoscopy 2 years ago.
Blood pressure is 126/80 mm Hg, pulse is 81/min, and BMI is 24 kg/m².  The abdomen is soft and nontender.  Rectal examination reveals guaiac-negative stool.  The remainder of the examination is normal.
Which of the following is the most appropriate management for this patient?

• A)Abdominal ultrasonography
• B)Barium swallow study
• C)Helicobacter pylori stool antigen testing
• D)Proton pump inhibitor for 6 weeks
• E)Upper gastrointestinal endoscopy

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