Consider the following medical report that includes the patient's historical health records. Use it to predict the disease that the patient is high likely exposed to. 

 Medical Report: allergies: patient recorded as having no known allergies to drugs attending: chief complaint: presyncope in setting of anemia major surgical or invasive procedure: egd history of present illness: mr. is a 60 year old gentleman with a pmh significant for ibs who was admitted with presyncope and anemia. the patient reports that this morning he was in the shower when he felt dizzy. he denies loss of consciousness or a fall, and "walked" to his pcp's office where he was found to have a hct of 20 and was then referred to the ed for further evaluation. the patient reports that the day before , he had an episode of presyncope while in the shower without loc. on , he had 1 episode of dark loose stools, followed by several subsequent smaller episodes. he denies any cp/sob, f/c/s, hematochezia, melena, n/v, palpitations, ha. the patient reports that he just completed a 4 week course of tetracycline for his ibs, and denies any asa or nsaid use. . in the ed, inital vs 98.4 95 139/64 20 100%ra. he was found to have a hct of 19.5, had a negative ngl, and was admitted to the micu for further management. past medical history: dupeytren's contact phenomenon in the hands and feet. ibs "lyme disease" social history: he is married for the past six years. tobacco - cigars. etoh - 4 glasses of scotch daily, estimates 8 oz pours (previously noted in omr as half a gallon of liquor a week to every ten days). denies history of withdrawal, seizures, or dts (was able to stop "cold " 2 years ago without problems. is a lawyer. family history: mother - ?irritable bowel syndrome and dementia. father - lymphoma. hx liver disease or gib. physical exam: vs: 98.4 31 138/63 18 99%ra gen: nad heent: sclerae icteric. eomi, perrl. mmm. op clear, neck supple without lad. cv: nl s1+s2, no m/r/g. pulm: ctab abd: s/nt/nd +bs. palpable liver edge 4-5 cm below costal margin. guaiac: performed in ed, brown positive ext: no c/c/e. skin: no spiders neuro: aox3, cn ii-xii intact. no asterixis. pertinent results: admission labs: 02:30pm glucose-97 urea n-25* creat-0.8 sodium-140 potassium-4.9 chloride-104 total co2-29 anion gap-12 02:30pm estgfr-using this 02:30pm alt(sgpt)-57* ast(sgot)-57* ld(ldh)-250 alk phos-64 tot bili-0.1 02:30pm albumin-3.5 02:30pm wbc-16.0* rbc-1.97* hgb-6.7* hct-19.5* mcv-99* mch-34.1* mchc-34.5 rdw-16.7* 02:30pm neuts-64.5 lymphs-30.6 monos-4.0 eos-0.5 basos-0.5 02:30pm plt count-502* 02:30pm pt-11.9 ptt-20.6* inr(pt)-1.0 discharge labs: 07:45am blood wbc-6.7 rbc-3.09* hgb-10.2* hct-29.5* mcv-96 mch-33.1* mchc-34.6 rdw-17.7* plt ct-542* 07:45am blood glucose-98 urean-13 creat-0.7 na-141 k-4.4 cl-105 hco3-30 angap-10 07:45am blood calcium-8.3* phos-3.5 mg-2.0 pertinent hematology: 12:46am blood hct-23.5* 12:57pm blood hct-27.8* 04:17pm blood wbc-9.1 rbc-3.05* hgb-10.1* hct-28.4* mcv-93 mch-33.0* mchc-35.5* rdw-18.4* plt ct-464* microbiology: helicobacter pylori antibody test (final ): negative by eia. studies: ct abdomen w/contrast study date of 1:25 pm impression: limited study due to oral contrast located more distally in loops of small and large bowel. no evidence of infiltrative duodenal or periduodenal lesion or perforation. no pathologically enlarged lymph nodes or concerning masses are noted. endoscopy: findings: esophagus: normal esophagus. stomach: normal stomach. duodenum: excavated lesions a single 4cm ulcer was found in the duodenal bulb. there was overlying hematin, slight oozing with scope contact but no active bleeding. impression: ulcer in the duodenal bulb otherwise normal egd to third part of the duodenum brief hospital course: 60 year old male that presented with a presyncopal episode found to have anemia with hct of 19. # anemia/gib: patient arrived to ed with hct of 20 and ng lavage that was positive for blood. pt admitted to micu for overnight monitoring and egd. he was transfused total of 3uprbcs in ed and micu, and went for egd hd#2, which showed a 4cm duodenal ulcer that had an overlying clot. patient remained stable after procedure and was called out to the floor. on the general medical floor, he was slowly advanced from clears to regular diet and tolerated this well. his hct was monitored and remained stable. he was transitioned to po ppi and was discharged with follow-up with gi and plans for a repeat egd in weeks. h pylori antibody testing returned negative while in house. # etoh: patient was placed on ciwa scale d/t concern for abrupt cessation of heavy etoh use, and was given a banana bag (though no evidence of malnutrition). he was given thiamine, folate, and mvi while in the hospital and discharged with mvi. he was told that decreasing his etoh use and improving his overall nutrition would improve his ulcer disease. he did not score on the ciwa or require any valium. transition of care: he was discharged with follow-up with his pcp and his gastroenterologist. no pending tests. medications on admission: tetracycline discharge medications: 1. multivitamin tablet sig: one (1) tablet po daily (daily). 2. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. disp:*60 capsule, delayed release(e.c.)(s)* refills:*2* discharge disposition: home discharge diagnosis: primary: upper gi bleed alcohol abuse secondary: irritable bowel syndrome discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: mr. it was a pleasure taking part in your care. you were admitted to because of weakness and anemia- or a low blood count. you were given a blood transfusion and your blood count improved and remained stable. you had an endoscopy and were found to have a large ulcer in your small bowel, just beyond the stomach, which was cause of your anemia. you were started on a medication called pantoprazole to decrease the acid in your stomach and to protect the ulcer, on discharge this medication was changed to omeprazole. you had a ct scan of your abdomen which was normal. you were in good condition at time of discharge, and you were tolerating a regular diet. . we made the following changes to your medications: - started omeprazole 40mg by mouth twice a day (please take this medication on an empty stomach, or 1hr prior to meals) - started multivitamin 1 tab by mouth daily . please take all other medications as prescribed. . alcohol is a likely cause of your ulcer, decreasing your consumption of alcohol would help prevent further ulcers and complications. . you will need a repeat endoscopy in weeks, which can be scheduled with your outpatient gastroenterologist followup instructions: please follow-up at the appointments below: name: , location: address: , , phone: appointment: tuesday 1:40pm name: , m. md department: gastroenterology location: address: , , phone: appointment: wednesday 10:20am procedure: other endoscopy of small intestine diagnoses: acute posthemorrhagic anemia chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction alcohol abuse, continuous irritable bowel syndrome 

Answer: The patient is high likely exposed to