SYMPTOMS
Abdominal pain, nausea and vomiting, anorexia
DIFFERENTIAL
Cardiac disease, ulcers, hernia, GERD, gastroparesis, functional dyspepsia,
pancreatitis, hepatitis, AAA, cholelithiasis
EXAM
Epigastric pain on palpation
DIAGNOSIS
■ Endoscopy with gastric biopsy
■ Nonbleeding gastritis is managed medically.
TREATMENT
■ Discontinue ASA, NSAID, or alcohol use.
■ Suspected gastritis without steroid evidence of bleeding may be treated with
a trial of viscous lidocaine and an antacid.
■ Consider prescribing a PPI or an over-the-counter H2 blocker.
■ Test for the presence of H. pyloriand treat with triple therapy if present
(see Table 11.1).
COMPLICATIONS
■ Ulcers or GI bleeding
■ Chronic atrophic gastritis may →lead to loss of gastric parietal cells
(and intrinsic factor production) →vitamin B 12 deficiency and perni-
cious anemia.
Gastric and Duodenal Ulcers
SYMPTOMS
■ Abdominal pain, nausea and vomiting, anorexia
■ Burning epigastric pain is the most common symptom. It may be relieved by
milk, antacids, and food. Food typically worsens gastric ulcers and relieves
duodenal ulcers. Duodenal ulcers get worse 2–3 hours after eating.
DIFFERENTIAL
Cardiac disease, hernia, gastritis, GERD, irritable bowel disease
EXAM
■ Epigastric pain on palpation
■ Abdominal distention due to obstruction, GI bleeding on rectal exam or
NGT tube placement, and abdominal rigidity from perforation indicate
acute complications.
DIAGNOSIS
Endoscopy with biopsy to rule out H. pyloriinfection and carcinoma
ABDOMINAL AND GASTROINTESTINALEMERGENCIESH. pylori serologic tests are
useful for past exposure but
cannot be used for test of
cure. Urea breath test,
endoscopic biopsy, and stool
antigen may be used for
diagnosis and to confirm
adequate treatment.If a patient has received H.
pyloritreatment but has
persistent symptoms, test for
eradication. If not eradicated,
treat again with a different
regimen. If eradicated, refer
for endoscopy.