18th July 2023

A 63-year-old man with a long history of dyspepsia has suffered with weight loss in the last 4 months

A 63-year-old man with a long history of dyspepsia has suffered with weight loss in the last 4 months. His general practitioner has also noted that he has iron-deficiency anaemia. He has a history of osteoarthritis for which he takes intermittent ibuprofen but is otherwise in good health. He was born in Japan and moved to the UK 10 years ago. He reports that his father died of gastric cancer. On physical examination of the abdomen, there are no abnormalities. He is referred for urgent 2-week-wait endoscopic assessment.

A colonoscopy was normal, but his gastroscopy revealed a gastric ulcer. Biopsies taken from the ulcer return as gastric adenocarcinoma. 3 years prior an OGD showed gastritis of the gastric antrum and on biopsy there was evidence of chronic inflammation. Colonoscopy with random biopsies 3 years ago was normal.

Which of the following is the most likely risk factor for his cancer?

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