Gastroenterology Question 11

A 67-year-old woman is evaluated during a routine examination. She has a history of hip and knee pain related to degenerative joint disease. The joint pain is now well controlled with diclofenac, which was started 3 months ago. A previous trial of high-dose acetaminophen was not effective. She does not have any gastrointestinal symptoms, and she takes the diclofenac with food most of the time. Her medical history is otherwise notable for type 2 diabetes mellitus, hyperlipidemia, and hypertension. Her parents both had coronary artery disease. Her medications are low-dose aspirin, metformin, chlorthalidone, simvastatin, and diclofenac.

On physical examination, vital signs are normal. Abdominal examination is unremarkable.

Which of the following is the most appropriate management?

A Change to enteric-coated aspirin

B Continue the current medication regimen

C Initiate omeprazole, 20 mg once daily

D Initiate omeprazole, 40 mg once daily

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