Her previous family physician, whom she left about two years ago, told her she had an ulcer, but no investigations were done. He prescribed H2-blockers, which she has taken off and on for the past three years. The patient feels that the pills help sometimes, but not consistently. She went to her new family physician who ordered an upper GI series, which was reported as showing a small hiatus hernia without reflux. The rest of the gastrointestinal functional enquiry was negative, except for constipation.
Past history is unremarkable.
The patient divorced four years ago and has two children who live with her. She works as an assistant manager at a bank. There are no financial concerns, though she finds her job occupies more time than she would like and there has been some conflict with the bank manager. She can't correlate any of these activities with her abdominal complaints. Family history reveals that her father has recently been diagnosed as having colon cancer.