The Patient with Dyspepsia

The Case

A 39-year-old woman comes to your office with a 9-month history of upper abdominal discomfort after eating. One year ago, she relocated to the United States from a rural area in Peru. She also complains of nausea and occasional heartburn, but denies vomiting, dysphagia, odynophagia, weight loss, melena, or hematochezia. She has no known family history of gastrointestinal malignancy or personal history of peptic ulcer disease. She takes an antacid as needed, but no prescribed medication or herbs. Six months ago, she had an abdominal ultrasound and HIDA scan of the gallbladder, which were normal.

Physical examination reveals mild epigastric tenderness with moderate palpation with no masses or lymphadenopathy. Blood count, liver enzymes, and renal function tests are normal.