Clinical Intake — Disease of stomach and duodenum

A 59-year-old male presents with an 8-month history of intermittent epigastric discomfort, nausea, and early satiety refractory to escalating proton pump inhibitor therapy. Prior cross-sectional imaging in December 2025 demonstrated gastric wall thickening with a 6 mm submucosal lesion of uncertain etiology, raising concern given a family history of gastric malignancy in a first-degree relative diagnosed at age 62. A prior attempt at intraluminal evaluation in September 2025 was aborted at the esophageal level due to severe gag reflex, leaving the gastric lesion uncharacterized. H. pylori has been excluded; hemoglobin is at the lower margin of normal. Dr. Reinhardt recommends further evaluation to characterize the submucosal lesion and exclude malignancy.