GERD and Peptic Ulcer Disease USMLE Step 1 Practice Question
A 52-year-old man with a 10-year history of gastroesophageal reflux disease presents with worsening epigastric pain and diarrhea over the past 2 months, despite adequate proton pump inhibitor therapy. He denies alarm symptoms such as dysphagia, weight loss, or melena. Upper endoscopy reveals a 2-cm ulcer in the gastric antrum. Urea breath test for Helicobacter pylori is negative. Fasting serum gastrin level is 850 pg/mL (normal <100 pg/mL), and gastric pH is 1.5. Which of the following is the most likely diagnosis?
Answer choices
- AMedication-induced peptic ulcer disease from chronic nonsteroidal anti-inflammatory drug use
- BGastric adenocarcinoma with secondary ulceration
- CCrohn disease involving the stomach with ulcerative manifestations
- DZollinger-Ellison syndromeCorrect answer
- EStress-related mucosal disease triggered by chronic GERD
- FH. pylori-negative peptic ulcer disease responsive to continued PPI monotherapy
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