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August 9, 1995

A 35-Year-Old Man With Epigastric Pain

JAMA. 1995;274(6):495-500. doi:10.1001/jama.1995.03530060069037

Dr Daley  : Mr H is a 35-year-old registered nurse who has recurrent episodes of epigastric pain. Divorced and the father of one child, he works in a local hospital and receives private health insurance through his employer.Since he was a child, Mr H has experienced intermittent pain in the epigastric area that radiates to the back. When the pain is mild, he describes it as burning, sometimes accompanied by chest heaviness or tightness. When the pain is severe, Mr H describes it as "a hot knife being pushed under my rib cage and out my back." His symptoms are aggravated by emotional stress, alcohol, cigarettes, and spicy foods. He denies nausea, vomiting, melena, hematemesis, symptoms of reflux, or anemia. He has never taken aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs). For many years, he took large quantities of antacids to relieve the pain, and sucralfate and cimetidine have also provided

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