Q. A 60-year-old man visits the emergency department with a three-day history of worsening epigastric pain accompanied by repeated bouts of coffee-ground emesis. His medical history is significant for chronic nonsteroidal anti-inflammatory drug (NSAID) use due to osteoarthritis. He is also a heavy smoker and drinks alcohol occasionally. The pain is described as a gnawing sensation, which is not relieved by food intake. He has also noticed a significant decrease in appetite and some weight loss over the past month.
Upon physical examination, the patient appears pale and slightly diaphoretic. Abdominal examination reveals epigastric tenderness but no evidence of peritoneal signs. Blood pressure is 100/60 mmHg, pulse 98 bpm, and respiratory rate 20 per minute.
Laboratory results show Hemoglobin: 9.2 g/dL, Hematocrit: 28.1%, BUN (Blood Urea Nitrogen): 36 mg/dL, Creatinine: 1.2 mg/dL, Platelet count: 250,000 cells/uL.
What is the most appropriate next step in the management of this patient?