A. Gastric Ulcer [1]

1. Helicobacter pylori associated (>90%)
2. NSAIDS (~10%)
3. EtOH
4. Zollinger Ellison Syndrome
5. Up to 10% of gastric ulcers contain adenocarcinoma

B. Adenocarcinoma [2]

1. Strong Associations: Smoking, Alcohol, H. pylori
2. Other assocations: pernicious anemia, smoked foods

C. Other Tumors

1. Lymphoma
   1. Mucosal Associated Lymphoma Tissue = MALT
   2. MALT Lymphomas are strongly associated with H. pylori
2. Leiomyosarcoma, Leiomyoma
3. Gastric Polyps - hyperplastic versus adenomatous
4. Hypertrophic Gastritis
   1. Gastrinoma (Usually pancreatic) - Zollinger Ellison Syndrome
   2. May include Multiple Endocrine Neoplasia Type 1 (MEN I)

D. Pernicious Anemia

1. Autoimmune destruction of parietal cells
2. Reduced acid secretion
3. Lack of intrinsic factor leads to vitamin B12 malabsorption
4. Histology shows chronic atrophic gastritis

E. Gastroparesis

1. Common in diabetics due to neuropathy
2. Scleroderma
3. Idiopathic

F. Mallory-Weiss Tear

1. Usually occurs with severe vomiting
2. Frequent cause of upper gastrointestinal bleeding in young persons

G. Other Lesions

1. Juvenile capillary hemangiomas of the stomach - may lead to hematemesis
2. Polyps
3. Arteriovenous malformations

H. Nonulcer Dyspepsia (NUD) [3]

1. Gastritis syndromes
2. Malabsorption - usually carbohydrates
3. Duodenitis
4. Biliary (enterogastric) reflux
5. Small-instestinal parasite, especially Giardia, Strongyloides
6. Chronic Pancreatitis
7. Psychiastric disorders
8. Reflux esophagitis - nonerosive
9. Gastroparesis - idiopathic, diabetic, others
10. Small intestinal dysmotility
11. Abnormal gallbladder and biliary tract motility 12 Functional dyspepsia - no organic lesions found (~60% of cases)

References

1. Laine L, Peterson WL. 1994. NEJM. 331(11):717
2. Fuchs CS and Mayer RJ. 1995. NEJM. 333(1):32
3. Moayyedi P, talley NJ, Fennerty MB, Vakil N. 2006. JAMA. 295(13):1566