A 52-year-old woman presents to the clinic complaining of abdominal pain for the past 3 months. She describes epigastric pain with a dull “gnawing and burning” quality that improves after eating. She has had success treating it with antacids but has recently noticed that they have become less effective. She denies chest pain, reflux, cough, hoarseness, hematemesis, melena, and weight loss. She endorses having diarrhea. She has a history of rheumatoid arthritis. Her medications include methotrexate and daily vitamin D.
She does not drink alcohol or smoke cigarettes. Which of the following is the most likely etiology of her condition?
- A) Antibodies against intrinsic factor
- B) Gastrinoma
- C) Gram negative bacillus that is catalase positive, urease positive, and oxidase negative
- D) Intestinal metaplasia
- E) Methotrexate