A 60-year-old man with a history of rheumatoid arthritis treated with NSAIDs presents with epigastric pain and a positive fecal occult blood test. He denies taking any gastroprotective agents. What is the likely diagnosis and what are the next steps?
This patient's epigastric pain and positive fecal occult blood test, in combination with chronic NSAID use without gastroprotection, suggest the presence of an NSAID-induced peptic ulcer. Discontinuing NSAIDs, if possible, and starting a proton pump inhibitor (PPI) would be the initial management steps. Upper endoscopy would be useful for diagnosing and assessing the extent of his ulcer disease.