On the ball! You note Mrs Doherty is both anaemic, complaining of indigestion and new onset constipation in the setting of recent weight loss. You are right to be concerned about gastro- intestinal pathology.

Pleasingly, her colonoscopy is normal. Her gastroscopy demonstrates a large prepyloric ulcer with erosion into the serosa.  Biopsies are taken that donít reveal any cancerous change, however she is H Pylori positive.

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