A 57-year-old man with peptic ulcer disease experiences transient - TopicsExpress

A 57-year-old man with peptic ulcer disease experiences transient improvement with Helicobacter pylori eradication. However, 3 months later symptoms recur despite acid-suppressing therapy. He does not take nonsteroidal anti-inflmmatory agents. Stool analysis for H. pylori antigen is negative. Upper GI endoscopy reveals prominent gastric folds together with the persistent ulceration in the duodenal bulb previously detected and the beginning of a new ulceration 4 cm proximal to the initial ulcer. Fasting gastrin levels are elevated and basal acid secretion is 15 meq/h. What is the best test to perform to make the diagnosis? A. No additional testing is necessary. B. Blood sampling for gastrin levels following a meal. C. Blood sampling for gastrin levels following secretin administration. D. Endoscopic ultrasonography of the pancreas. E. Genetic testing for mutations in the MEN1 gene.

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