MKSAP: 50-year-old man with a large bleeding gastric ulcer

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 50-year-old man is evaluated in follow-up after hospitalization 6 months ago for a large bleeding gastric ulcer. Tests performed for Helicobacter pylori infection at that time were negative. However, for the 3 months before hospitalization he had been taking ibuprofen for chronic back pain. He was discharged from the hospital on omeprazole, and his ibuprofen was discontinued. Owing to the large size of the ulcer and increased suspicion for underlying malignancy, follow-up upper endoscopy was performed 3 months later and showed complete ulcer healing; the omeprazole was stopped. He has not found any other treatment as effective as ibuprofen for his back pain, and he wishes to restart the ibuprofen. He does not have cardiovascular disease and is at low risk for developing cardiovascular disease. Physical examination is unremarkable. Which of the following is the most appropriate management? A: Celecoxib B: Celecoxib and omeprazole C: Ibuprofen D: Ibuprofen and sucralfate Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: Tags: Conditions GI Source Type: blogs