Discussion Case Background: A 35-year old accountant presented to his physician with a steady burning pain just right of the mid-line of the abdominal region in an area from 1 to 4 inches above the “belly button.” The pain usually followed meals by about 1-3 hours. He had several episodes of vomiting, which included frank blood. On physical examination, the patient had no fever. He appeared generally well. He had no evidence of weight loss. He showed slight rebound tenderness in the upper abdomen. An occult blood test revealed the presence of blood.