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Question 3#

 A 56-year-old woman becomes the chief financial officer of a large company and, several months thereafter, develops upper abdominal pain that she ascribes to stress. She takes an over-the-counter antacid with temporary benefit. She uses no other medications. One night she awakens with nausea and vomits a large volume of coffee grounds-like material; she becomes weak and diaphoretic. Upon hospitalization, she is found to have an actively bleeding duodenal ulcer. Which of the following statements is true?

A) The most likely etiology is adenocarcinoma of the duodenum
B) The etiology of duodenal ulcer is different in women than in men
C) The likelihood that she harbors Helicobacter pylori is greater than 50%
D) Lifetime residence in the United States makes H pylori unlikely as an etiologic agent
E) Organisms consistent with H pylori are rarely seen on biopsy in patients with duodenal ulcer

Correct Answer is C

Comment:

Duodenal ulcer is more common in men than women, but H pylori is present in 70% of patients (men and women) who have a duodenal ulcer not associated with NSAID ingestion. In gastric ulcer disease, the incidence of H pylori is 30% to 60%. Helicobacter pylori is more common in developing countries but is often seen in the United States. It is more common in patients with low socioeconomic status, in particular those with unsanitary living conditions, which suggests that H pylori is transmitted by fecal-oral or oral-oral routes. In patients with duodenal ulcer, organisms consistent with H pylori are frequently seen on biopsy. Before the discovery of H pylori, most duodenal ulcers would reoccur. Adenocarcinoma of the duodenum is a rare cause of upper gastrointestinal bleeding.