Jacob is a 45-year-old Construction foreman who presents to the clinic complaining of gastric distress and an associated lightheadedness.

Jacob is a 45-year-old Construction foreman who presents to the clinic complaining of gastric distress and an associated lightheadedness. He is also experiencing excruciating intermittent pain in his kidney area radiating across his abdomen and into his genital area. Jacob has been treated for hypertension for five years but denies any known cardiac history. He was diagnosed with Diabetes Type II last year for which he takes metformin. His weight is stable, and he claims to have an excellent appetite. He has a normal bowel habit and has not seen and black stools, but he hasn’t looked. He has noticed an increased frequency of urination and a moderate amount of hematuria. Denies any previous surgeries. Upon further questioning, he states that his stools are not only black but are sticky and smell bad. He further complains of recent worsening of a chronic epigastric burning which had been a problem off/on for years. He had doubled his usual dose of Tums without significant relief of the burning. He has 2-3 beers after work and sometimes a cocktail before dinner. He takes NSAIDs as needed for back pain and recently started on one aspirin per day for cardiac prophylaxis. He smokes two packs of cigarettes per day and an occasional cigar. He was told of an ulcer in the distant past but had no specific evaluation or treatment for same. positive CVA, positive H. Pylori. What is his diagnosis?

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