18th July 2023

You see a 54-year-old man in a gastroenterology clinic with an 8-month history of dyspepsia

You see a 54-year-old man in a gastroenterology clinic with an 8-month history of dyspepsia. He complains that he has had watery, pale stools, which have been malodorous and difficult to flush. His GP prescribed omeprazole 20mg daily 4 months ago, which has failed to relieve his symptoms. Abdominal examination was unremarkable other than some mild epigastric tenderness. You request an OGD, which reveals 6 small peptic ulcers and 2 duodenal ulcers. A subsequent capsule endoscopy demonstrates 3 jejunal ulcers.

His observations are as follows:

Temperature 37.2oC

Heart Rate 90

Blood Pressure 125/70

Respiratory Rate 15

Oxygen saturation 98% RA

Given the likely diagnosis, what is the next most appropriate investigation?

Select the SINGLE most appropriate option from the list below. Select ONE option only.