A 55-year-old man on long-term aspirin and ibuprofen presents with a 12 mm gastric ulcer near the incisura. Rapid urease test is positive. After H. pylori eradication and 8 weeks of PPI therapy, what is the next mandatory step?
- A No further investigation needed if symptoms resolve
- B Repeat endoscopy with biopsy of the ulcer to confirm healing and exclude malignancy ✓
- C H. pylori breath test to confirm eradication only, no endoscopy needed
- D Long-term PPI without repeat endoscopy is sufficient management
Correct answer: B. Repeat endoscopy with biopsy of the ulcer to confirm healing and exclude malignancy
Explanation
All gastric ulcers require repeat endoscopy with multiple biopsies (at least 6–8) after 8–12 weeks of treatment to confirm healing and to exclude underlying gastric malignancy, as even benign-appearing ulcers can harbour carcinoma. Duodenal ulcers in contrast do not require routine follow-up endoscopy unless complicated or suspicious. The combination of NSAID use and positive H. pylori increases malignancy risk, making histological confirmation essential.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.