A 70-year-old patient with abdominal pain and vomiting brown material after significant stress; which diagnosis is most likely?

• A. Gastric ulcer caused by stress.
• B. Gastritis from NSAID use.
• C. Duodenal ulcer.
• D. Esophagitis from reflux.

Answer: (A)

The key idea is that severe physiological stress can cause stress-related ulcers in the stomach, leading to an upper GI bleed. When the stomach lining is damaged by stress, mucosal blood flow falters and an acute gastric ulcer can form, and bleeding can occur. Vomiting brown material is typical of digested blood from an upper GI source (coffee-ground appearance), which fits a bleeding gastric ulcer.

In this scenario, the significant stress anchors the diagnosis toward a stress-related gastric ulcer rather than other patterns. Duodenal ulcers tend to present with epigastric pain that often improves with meals and aren’t as tightly linked to a recent stressful event. Gastritis from NSAID use could cause abdominal discomfort and bleeding but doesn’t specifically hinge on a recent stress event. Esophagitis from reflux usually causes heartburn and regurgitation rather than acute upper GI bleeding with brown vomitus after a stress episode.

So, a stress-related gastric ulcer best explains abdominal pain with vomiting brown material following significant stress.