A. Gastric Ulcer [1]
- Helicobacter pylori associated (>90%)
- NSAIDS (~10%)
- EtOH
- Zollinger Ellison Syndrome
- Up to 10% of gastric ulcers contain adenocarcinoma
B. Adenocarcinoma [2]
- Strong Associations: Smoking, Alcohol, H. pylori
- Other assocations: pernicious anemia, smoked foods
C. Other Tumors
- Lymphoma
- Mucosal Associated Lymphoma Tissue = MALT
- MALT Lymphomas are strongly associated with H. pylori
- Leiomyosarcoma, Leiomyoma
- Gastric Polyps - hyperplastic versus adenomatous
- Hypertrophic Gastritis
- Gastrinoma (Usually pancreatic) - Zollinger Ellison Syndrome
- May include Multiple Endocrine Neoplasia Type 1 (MEN I)
D. Pernicious Anemia
- Autoimmune destruction of parietal cells
- Reduced acid secretion
- Lack of intrinsic factor leads to vitamin B12 malabsorption
- Histology shows chronic atrophic gastritis
E. Gastroparesis
- Common in diabetics due to neuropathy
- Scleroderma
- Idiopathic
F. Mallory-Weiss Tear
- Usually occurs with severe vomiting
- Frequent cause of upper gastrointestinal bleeding in young persons
G. Other Lesions
- Juvenile capillary hemangiomas of the stomach - may lead to hematemesis
- Polyps
- Arteriovenous malformations
H. Nonulcer Dyspepsia (NUD) [3]
- Gastritis syndromes
- Malabsorption - usually carbohydrates
- Duodenitis
- Biliary (enterogastric) reflux
- Small-instestinal parasite, especially Giardia, Strongyloides
- Chronic Pancreatitis
- Psychiastric disorders
- Reflux esophagitis - nonerosive
- Gastroparesis - idiopathic, diabetic, others
- Small intestinal dysmotility
- Abnormal gallbladder and biliary tract motility 12 Functional dyspepsia - no organic lesions found (~60% of cases)
References
- Laine L, Peterson WL. 1994. NEJM. 331(11):717
- Fuchs CS and Mayer RJ. 1995. NEJM. 333(1):32
- Moayyedi P, talley NJ, Fennerty MB, Vakil N. 2006. JAMA. 295(13):1566