A 70-Year-Old Man Comes to the Office Due to Persistent

A 70-year-old man comes to the office due to persistent epigastric discomfort and nausea for the past several months.  He has also noticed black-colored stools on several occasions.  Medical history is notable for hypertension and osteoarthritis.  The patient emigrated from rural China 5 years ago to live with his daughter.  He does not use tobacco, alcohol, or illicit drugs.  Physical examination shows a thin male with pale mucous membranes, an enlarged left supraclavicular lymph node, and epigastric tenderness on deep palpation.  Stool testing for occult blood is positive.  Upper gastrointestinal endoscopy reveals a 3-cm ulceration at the gastric antrum, with a heaped-up irregular border.  Biopsy from the edge of the ulcer reveals glandular structures containing intestinal-like columnar cells.  Which of the following most likely predisposed this patient to his current condition?

A) Chronic use of nonsteroidal anti-inflammatory drugs
B) Excessive consumption of salt-preserved foods
C) Frequent intake of high-temperature beverages
D) Functional disruption of gastroesophageal junction
E) Increased gastrin production from a pancreatic mass

Correct Answer:

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