A 60-year-old man is found to have a gastric ulcer at endoscopy. Biopsies are reported as benign. According to standard recommendations, what is the appropriate follow-up?

Answer: D. Repeat endoscopy in 8-12 weeks to confirm healing

Follow-up of a gastric ulcer

A gastric ulcer with benign biopsies still needs follow-up because early, curable cancers can be missed and because some gastric cancers present as ulcers.

Standard recommendation

• Repeat endoscopy in 8-12 weeks to verify healing.
• Non-healing ulcers need repeat biopsies, since a malignant ulcer may not heal.

Why this matters

• About 25% of patients with gastric cancer have a history of a gastric ulcer.
• Although repeat endoscopy raises cost-effectiveness questions, small curable lesions may be missed without follow-up.

Contrast with duodenal ulcers

Duodenal ulcers are almost never malignant and do not require the same routine repeat endoscopy; the concern about malignancy and the need for follow-up healing checks applies specifically to gastric ulcers.

Take-home

Treat the ulcer (eradicate H. pylori, acid suppression), then confirm healing endoscopically and re-biopsy if it has not healed.