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A 46-year-old lady presented with a 3-month history of severe, worsening epigastric discomfort. This pain was associated with increasingly frequent episodes of vomiting. Her repeated vomiting led to weight loss of 6.5 kg. A trial of metoclopramide produced some initial symptomatic relief but its beneficial effects subsequently wore off.
Clinical examination revealed some tenderness in the upper abdomen. Blood tests showed unremarkable haematological and biochemical profiles, with normal inflammatory markers. At upper gastrointestinal endoscopy there was circumferential …
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