Abstract
A 57-year-old man was referred for investigation of asymptomatic anemia and occult blood in his stool. Upper endoscopy revealed patchy duodenitis and an ulcer in the distal duodenal bulb (FigureA). Despite appropriate therapy, his anemia persisted, and a repeat upper endoscopy 6 months later showed a persistent duodenal ulcer. At this point serum gastrin level was checked and found to be normal. A computed tomography scan of his abdomen suggested duodenal wall thickening in the proximal and mid-descending duodenum.
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