Introduction

A 50-year-old man and active smoker presented with a 4-week history of general malaise, exertional dyspnoea, abdominal pain and weight loss. He had a medical history of epilepsy and excess alcohol consumption with recurrent falls resulting in injuries including an L3 end-plate fracture. He had been taking naproxen and paracetamol for his injuries. Abdominal and rectal examination revealed mild epigastric tenderness and normal bowel sounds. He was haemodynamically stable with no stigmata of chronic liver disease. Bloods showed a normocytic anaemia with a haemoglobin of 81 g/L, and his liver and renal functions were within normal range. There was evidence of active inflammation with a C …