A 29-year-old man with a long history of heartburn and dyspepsia presents to the primary care doctor with severe mid-epigastric pain. He was initially treated with an H2 blocker twice a day. He immediately had relief but his symptoms returned after two weeks. What is the most likely cause for the relapse in his symptoms?

  •  Outlet obstruction due to fibrous tissue repair
  •  Giardia lamblia infection
  •  Helicobacter pylori infection
  •  Acute gastric ulcerations
  •  Tapeworm infestation