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PEER RESPONSE WITH REFERENCES: The patient’s constellation of pallor, hemoglobin 8.5 g/dL, early satiety, gnawing epigastric pain, and mild epigastric tenderness most strongly suggests iron-deficiency anemia caused by chronic upper-gastrointestinal blood loss from a peptic ulcer; the recent cognitive slowing is plausibly anemia-related and should improve once hemoglobin rises (Cotter et al., 2020). Her otherwise normal cardiopulmonary examination, absence of melena or hematemesis, and lack of inflammatory markers point away from an acute hemorrhage or inflammatory bowel disease, reinforcing the diagnosis of occult ulcer bleeding. Therapy should address the anemia and also find and stop the bleeding. I recommend using omeprazole 40 mg orally once daily, 30 minutes before breakfast, for at least eight weeks, since it helps ulcers heal faster and reduces the chance of another bleed (Laine et al., 2021). During the wait for endoscopy, I would give ferrous sulfate 325 mg (65 mg iron) orally three times a day, on an empty stomach with 250 mg of vitamin C or orange juice to help absorption. This formulation usually replenishes iron unless there is a problem with absorption (Laine et al., 2021). If you have occasional nausea, you may take an ondansetron orally disintegrating tablet 4 mg every six hours, but no more than 8 mg in 24 hours. As testing for Helicobacter pylori is now required in all suspected peptic-ulcer cases, I would perform a urea breath test today; if it comes back
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