Differential Diagnosis

PUD Gastric ulcer Duodenal ulcer Erosive gastritis Zollinger- Ellison Syndrome Gastrointestinal tumors

Gastric ulcer Majority of GUs can be attributed to either H. pylori infection or NSAID induced mucosal damage Type I - located near the angularis incisura on the lesser curvature, close to the border between the antrum and the body of the stomach. These patients usually have normal or decreased acid secretion.

Gastric ulcer Type II - associated with active or quiescent duodenal ulcer disease Type III - prepyloric Type IV- near the gastroesophageal junction, and acid secretion is normal or below normal Type V- any location, associated with NSAID use

Duodenal ulcer Acid secretory abnormalities that is also caused by H. pylori infection Bicarbonate secretion is significantly reduced in patients with DU Role of NSAIDS in inducing mucosal damage

Erosive gastritis caused by many factors, including infection, injury, certain drugs, and disorders of the immune system. involves both inflammation and wearing away of the stomach lining. results from irritants such as drugs, especially aspirin and other nonsteroidal anti-inflammatory drugs Painless upper GI bleeding in ICU setting

Zollinger- Ellison Syndrome increased levels of the hormone gastrin are produced, causing the stomach to produce excess hydrochloric acid a tumor (gastrinoma) of the duodenum or pancreas producing the hormone gastrin. Gastrin then causes an excessive production of acid which can lead to peptic ulcers in almost 95% of patients.

Gastrointestinal tumors one of the most common mesenchymal tumors of the gastrointestinal tract Patients present with trouble swallowing, gastrointestinal hemorrhage or metastases