A 45-year-old male presents with symptoms of epigastric pain, worsened with ingestion of food. Physical examination is normal. Upper abdominal ultrasonography is unremarkable. Contrast radiography reveals a 2 cm ulcer in the gastric fundus along the lesser curvature. Therapy with omeprazole 20 mg per day is begun but symptoms persist 3 weeks later. Appropriate management includes which of the following?
A. Increase in omeprazole dose to 40 mg per day
B. Addition of sucralfate 1 gm every 8 hours
C. Addition of cimetidine 200 mg b.i.d.
D. Esophagogastroduodenoscopy with biopsy of ulceration
Answer:D
A 45-year-old male presents with symptoms of epigastric pain, worsened with ingestion of food. Physical examination is normal. Upper abdominal ultrasonography is unremarkable. Contrast radiography reveals a 2 cm ulcer in the gastric fundus along the lesser curvature. Therapy with omeprazole 20 mg per day is begun but symptoms persist 3 weeks later. Appropriate management includes which of the following?
A. Increase in omeprazole dose to 40 mg per day B. Addition of sucralfate 1 gm every 8 hours C. Addition of cimetidine 200 mg b.i.d. D. Esophagogastroduodenoscopy with biopsy of ulceration