Differentials
Hiatal hernia
SIGNS / SYMPTOMS
Commonly presents as heartburn and gastro-oesophageal reflux.
INVESTIGATIONS
Endoscopy shows absence of varices.
Gastric varices
SIGNS / SYMPTOMS
These patients may have evidence of chronic liver disease but may or may not have cirrhosis: for example, splenic vein thrombosis leads to isolated gastric varices.
Patients who have oesophageal varices may also have gastric varices.
INVESTIGATIONS
Endoscopy shows gastric varices but none in oesophagus.
Often gastric varices are an extension of oesophageal varices, but isolated gastric varices can also be found.
Mallory-Weiss tear
SIGNS / SYMPTOMS
Small and self-limited episodes of haematemesis and/or malaena; preceded by forceful or recurrent retching, vomiting, coughing, or straining.
INVESTIGATIONS
Endoscopy shows lacerations of oesophageal mucosa.
Peptic ulcer disease
SIGNS / SYMPTOMS
Most commonly presents as heartburn. In active bleeding from an ulcer it may be difficult to distinguish from variceal bleeding.
INVESTIGATIONS
Endoscopy shows peptic ulcer disease with ulcers in the stomach and/or duodenum.
Gastric antral vascular ectasia
SIGNS / SYMPTOMS
Absence of signs of liver disease.
INVESTIGATIONS
Endoscopy shows multiple erythematous mucosal linear streaks in the antrum.
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