A 42-Year-Old Woman Is Evaluated for Chronic Abdominal Pain and Fatigue

A 42-year-old woman is evaluated for chronic abdominal pain and fatigue.  Her pain is epigastric, burning, and sometimes awakens her from sleep.  She has no recent weight loss, nausea, or vomiting.  Her diet consists primarily of fruits and vegetables.  The patient also complains of a "strange appetite" for paper and ice that she has never had before.  Upper gastrointestinal endoscopy shows duodenal erythema and an ulcer on the anterior wall of the duodenal bulb but is otherwise normal.  Her unusual appetite is most directly related to which of the following?

A) Chronic bleeding
B) Helicobacter pylori infection
C) Lactose intolerance
D) Oral leukoplakia
E) Reflux esophagitis
F) Vitamin B12 deficiency

Correct Answer:

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