Review Question - QID 108909

A 38-year-old man presents to his primary care provider for abdominal pain. He has a dull, burning pain that has progressively worsened. He notes a weight loss of 5 pounds over that time frame. The patient endorses nausea and feels that the pain is worse after meals, but he denies any vomiting or diarrhea. He has a medical history of hypertension and lower back pain. He reports that he has been under an unusual amount of stress since losing his job as a construction worker. His home medications include enalapril and ibuprofen. The patient drinks 1-2 beers with dinner weekly and has a 1 pack-year smoking history that he stopped 15 years ago. His family history is significant for colorectal cancer in his father and leukemia in his grandmother. His temperature is 98.6°F (37°C), blood pressure is 132/95 mmHg, pulse is 72/min, and respirations are 12/min. On physical exam, the patient is moderately tender to palpation in the epigastrium. A fecal occult test is positive for blood in the stool. Which of the following elements in the patient’s history is most likely associated with the cause of this patient's symptoms?