TJ is a fifty-five-year-old police officer who presents to the clinic with complaints of epigastric pain for two weeks.

TJ is a fifty-five-year-old police officer who presents to the clinic with complaints of epigastric pain for two weeks. He has been taking over-the-counter (OTC) Zantac without relief. He was diagnosed about a year ago with a bleeding ulcer, and he expresses concerns that the current symptoms remind him of that event. At that time, he was given “multiple prescriptions” for his stomach, but he did not complete the course of therapy because he began to feel better. He also has osteoarthritis in his wrists and hips, for which he takes OTC NSAIDs. He smokes one to two packs per week and drinks an average of one alcoholic beverage daily. His vital signs and blood work are all within normal limits. Answer the following questions:

What additional testing would you suggest at this point?
Describe any and all variables that could be contributing to his symptoms.
What alterations would you suggest in his treatment? Be sure to consider additional diagnoses and whether prophylaxis would be appropriate for NSAID-induced ulcers.

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