A 61-year-old American woman was referred to the Gastroenterology Clinic from primary care provider due to consistent discomfort and significant weight loss. She saught for a PCP as she had a tarry stool in the early morning which she had never experienced before. She presented with a 2-month history of burning pain in the epigastric abdomen and chest which radiated toward her back. Her pain was worsened after taking aspirin, NSAIDs, and caffeine drink, and relieved after taking antacids. She had lost 10 pounds in 2 months due to decreased intake caused by the feeling of bloating, early fullness and stomach between meals. She also stated nausea and vomited twice, one of them even with the undigested food. Recently, her knee pain increased so she doubled the NSAIDs dosage by herself. She looked pallor and exhausted when she entered the clinic.
Past medical history
- Gastritis with Helicobacter pylori (H. pylori) infection, age 5 years. resolved with pharmacotherapy, frequent recurrence.
- Heat attack 3 months ago, has started taking aspirin since then.
- Osteoarthritis, age 3 years. Long-term use of the non-steroidal anti-inflammatory drug (NSAID) since diagnosis.
- Acute pancreatitis, age 5 years, resolved with pharmacotherapy, no recurrence.
- Chronic obstructive pulmonary disease, age 11 years.
- Diabetes Mellitus and hypertension diagnosed 6 years ago.
- No surgical history.
Pertinent family history
- Mother died from gastric cancer at age 67 years old.
- Father alive, has smoked for 50 years and now has a small-cell carcinoma. Live with the patient since she divorced her husband.
- Brother alive and well at age 56 years, had a history of duodenal ulcers. Heavy smoker.
- Ex-husband at age 62, alive and has COPD.
- One son alive and well at age 29.
- One daughter at age 35, alive and has recurrent Gastritis.
Pertinent social history
- Has worked full-time as a TV program producer for 30 years.
- Had divorced with her husband 20 years ago, after then, raises the 2 children by herself.
- Hobbies include drinking, eating spicy food, watching dramas and talkshow.
- Has smoked for 30 years, even after the diagnosis of COPD, still cannot quit smoking.