رجل عمره ٦٤ سنة عنده شبع مبكر وألم في أعلى البطن منذ شهرين، ونقص وزنه ٨ كغ، وتعب. الهيموغلوبين ٩٫١ مع نقص حديد. يدخن ويأكل مخللات ومملحات كثيراً، وأبوه توفي بسرطان المعدة. ما الإجراء الأنسب؟

A 64-year-old man has had early satiety and epigastric pain for two months, has lost 8 kg and is tired. Hb 9.1 g/dL with iron deficiency. He smokes, eats a lot of pickled and salted food, and his father died of gastric cancer. What is the most appropriate action?

1. Iron tablets only and review in a year
2. A weight-loss diet since early satiety is normal
3. Six months of antacids, then reassess
4. Urgent upper endoscopy with biopsies

Answer: D) Urgent upper endoscopy with biopsies. Early satiety, weight loss and anaemia after 50 with risk factors are red flags for gastric cancer, needing urgent endoscopy with biopsies.