A 64-Year-Old Man Comes to the Office Due to Persistent

A 64-year-old man comes to the office due to persistent upper abdominal pain and nausea.  He experienced epigastric discomfort after taking ibuprofen for an ankle injury several months ago.  He stopped taking ibuprofen and took omeprazole for 2 weeks, which provided some relief.  However, when he stopped omeprazole his pain started again and has progressively worsened.  The patient also has occasional nausea and loss of appetite.  He has a remote history of tobacco use but no other medical problems.  He immigrated to the United States from Laos 20 years ago.  Physical examination reveals minimal epigastric tenderness.  Upper gastrointestinal endoscopy demonstrates mild gastric erythema and a 4-cm mass in the body of the stomach along the greater curvature.  Several biopsies are obtained and histopathology is consistent with low-grade lymphoma arising from the mucosa-associated lymphoid tissue (MALT) .  Imaging studies reveal no lymphadenopathy or metastatic disease.  Which of the following is most likely involved in the pathogenesis of this patient's current condition?

A) Cigarette smoking
B) Frequent nonsteroidal anti-inflammatory drug use
C) Helicobacter pylori infection
D) N-nitroso compounds
E) Pernicious anemia
F) Salt-preserved foods

Correct Answer:

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