GERD and Peptic Ulcer Disease USMLE Step 1 Practice Question
A 42-year-old man presents to your clinic with a 6-month history of progressive epigastric pain and chronic diarrhea refractory to treatment with omeprazole 20 mg daily. He completed triple therapy for H. pylori infection 3 months ago with documented eradication by urea breath test. He denies NSAID use, alcohol abuse, or aspirin. Vital signs are stable. Upper endoscopy reveals multiple large duodenal ulcers and severe erosive esophagitis. Laboratory studies show: fasting serum gastrin 1,400 pg/mL (normal <100 pg/mL), gastric pH 1.5, and normal liver and renal function. Which of the following is the most likely diagnosis?
Answer choices
- AH. pylori reinfection with treatment-resistant strain
- BMedication-induced ulcer recurrence secondary to proton pump inhibitor discontinuation
- CCrohn disease with gastroduodenal involvement
- DZollinger-Ellison syndrome from a sporadic gastrinomaCorrect answer
- EMultiple endocrine neoplasia type 1 with gastrinoma
- FSevere gastroesophageal reflux disease with secondary ulceration
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