02-29-2008, 07:47 AM
A 66-year-old woman has a 2-month history of intermittent burning epigastric pain that is worse at night and during fasting. She has mild nausea but no vomiting, melena, or hematochezia. The patient has lost 1.3 kg (3 lb) during this time. Over-the-counter antacids have not relieved the pain. She has mild hypertension and incapacitating degenerative joint disease. Medications include a daily thiazide diuretic and ibuprofen three times daily.
Physical examination reveals epigastric tenderness to palpation and degenerative joint changes in the hands. Upper endoscopy demonstrates several superficial antral erosions and a 7-mm ulcer in the duodenal bulb. Antral biopsy specimens show chemical-induced gastropathy and no evidence of Helicobacter pylori. The patient refuses to stop taking ibuprofen because of the incapacitating pain in her hands.
Which of the following is the most appropriate next step in managing this patient?
A- An H2-receptor antagonist
B- A liquid antacid
C- A proton pump inhibitor
D- A prostaglandin-E1 analogue
E- Sucralfate
Physical examination reveals epigastric tenderness to palpation and degenerative joint changes in the hands. Upper endoscopy demonstrates several superficial antral erosions and a 7-mm ulcer in the duodenal bulb. Antral biopsy specimens show chemical-induced gastropathy and no evidence of Helicobacter pylori. The patient refuses to stop taking ibuprofen because of the incapacitating pain in her hands.
Which of the following is the most appropriate next step in managing this patient?
A- An H2-receptor antagonist
B- A liquid antacid
C- A proton pump inhibitor
D- A prostaglandin-E1 analogue
E- Sucralfate