The examination is normal except for slight epigastric discomfort. He complains of a decreasing appetite because of the discomfort. He admits that he has been under more stress during this period of time. He has lost about 8 lbs over the last 2 months. She complains of occasional reflux symptoms at bedtime which wakes her up.
Physical examination demonstrates mild epigastric tenderness.
All of her laboratory tests are negative including non-invasive testing for H. pylori. Unlike in H. pylori ulcers, maintenance therapy is seldom required. All of these statement are true. He complains of an acute exacerbation of pain within the past 45 minutes which he states is now radiating to his back. His abdomen is exquisitely tender with positive rebound and absence of bowel sounds.