Differentials
Peptic ulcer disease (PUD)
SIGNS / SYMPTOMS
Clinical signs and symptoms may be similar.
INVESTIGATIONS
Peptic ulcer disease is strongly associated with Helicobacter pylori infection and non-steroidal anti-inflammatory drugs (NSAIDs) use.[4]
Faecal occult blood test may be positive, indicating occult gastrointestinal bleeding. Frank blood in the stool suggests brisk bleeding.
Endoscopy shows presence of peptic ulcer.
Gastro-oesophageal reflux disease (GORD)
SIGNS / SYMPTOMS
Clinical signs and symptoms may be similar.
GORD is characterised by specific oesophageal and extra-oesophageal symptoms.[46]
INVESTIGATIONS
H pylori urea breath test is negative.
Endoscopy and oesophageal histology show oesophageal involvement.
Non-ulcer dyspepsia
SIGNS / SYMPTOMS
Clinical signs and symptoms may be similar to symptomatic gastritis and PUD.
Gastric lymphoma
SIGNS / SYMPTOMS
Clinical signs and symptoms may be similar.
INVESTIGATIONS
Gastric mucosa-associated lymphoid tissue (MALT) lymphoma is strongly associated with H pylori infection.[4] Faecal occult blood test may be positive, indicating occult GI bleeding.
Endoscopy may show presence of ulcer or non-specific mucosal abnormalities. Biopsies show histologically abnormal lymph follicle architecture with variable number of blast cells.
Molecular cytogenetics (e.g., reverse transcriptase polymerase chain reaction [PCR] or fluorescence in situ hybridisation) may show characteristic t(11;18) translocation within lymphoid cells.
Gastric carcinoma
SIGNS / SYMPTOMS
Patient may have suspicious features (e.g., bleeding, anaemia, early satiety, unexplained weight loss [>10% body weight], progressive dysphagia, odynophagia, or persistent vomiting).
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