A 62 year old woman is referred to you for evaluation of a 6 week history of gnawing epigastric pain associated with nausea and anorexia. She relates that the pain becomes worse about 30 minutes after eating. Her past medical history is significant for rheumatoid arthritis and hypertension. She takes Naprosyn and Felodapine for these problems. On physical examination she is a thin woman in no acute distress with moderate deep tenderness to palpation in the epigastrium.