CAUSES :
1. COMMON CAUSES
- DUODENAL ULCER
- GASTRIC ULCER
- GASTRITIS - IMMUNE OR H-PYLORI
- GASTRIC CANCER
- HIATUS HERNIA
- OESOPHAGEAL REFLUX
- IRRITABLE BOWEL SYNDROME
- DRUGS LIKE TOBACCO , ALCOHOL , NSAID , THEOPHYLLINE , DIGOXIN , IRON PREPARATION , CYTOTOXIC DRUGS , ANTIBIOTICS
- GALL STONES
- PSYCHIATRIC DISORDERS LIKE TENSION , DEPRESSION
- FOOD INTOLERANCE
- AEROPHAGY
- PREGNANCY
2. LESS COMMON CAUSES
- OTHER GASTRIC TUMORS LIKE LYMPHOMA , LEIOMYOSARCOMA
- OTHER GASTRIC DISEASES LIKE SARCOIDOSIS , TUBERCULOSIS , EOSINOPHILIC GRANULOMA , SYPHILIS
- AC HYPERTROPHIC PYLORIC STENOSIS
- HYPERTROPHIC GASTRITIS( MENETRIER DISEASE )
- DUODENITIS
- OTHER DUODENAL DISEASES LIKE WEBS , POLYPS , CANCER , LYMPHOMA
- CHR PANCREATITIS
- PANCREATIC CANCER
- CROHN S DISEASE
- COLONIC CANCER
- METABOLIC DISEASES LIKE DIABETES MELLITUS , URAEMIA , ADRENAL INSUFFICIENCY , HYPERTHYROIDISM , HYPOTHYROIDISM , HYPERCALCAEMIA
- COELIAC DISEASE
- TROPICAL SPRUE
- CHR HEPATITIS
- PUL TUBERCULOSIS
- CONGESTIVE CARDIAC FAILURE
- AUTONOMIC NEUROPATHY
- GASTRIC & SMALL INTESTINAL MOTILITY DISORDERS
- GIARDIASIS
- STROGYLOIDIASIS
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DIFFERENTIAL DIAGNOSIS
β’ Gastroesophageal reflux
β’ Cholecystitis
β’ Peptic ulcer disease
β’ Gastric cancer
β’ Esophageal spasm
β’ Malabsorption syndromes
β’ Pancreatic disease
β’ Irritable bowel syndrome
β’ Aerophagia
β’ Ischemia heart disease
β’ Diabetes mellitus
β’ Thyroid disease
β’ Connective tissue disorders
β’ Conversion disorder
β’ CBC
β’ Chemistry panel
β’ Stool for occult blood
SPECIAL TESTS :
. Esophageal manometry (rarely needed)
. 24-hour intra-esophageal pH monitoring (rarely needed)
IMAGING :
. Recommended in:
. Patients over 45 years of age at onset of symptoms
. Patients with symptoms and signs suggesting more serious disease
. Patients who need added reassurance
. Younger patients who do not respond rapidly to empiric treatment
. Usual:
. Endoscopy, or
. Upper GI series
. Sometimes:
. Barium enema
. Gallbladder studies (e.g., ultrasound or oral cholecystogram)
. Nuclear medicine gastric emptying study (in selected cases)
DIAGNOSTIC PROCEDURES :
. Careful history and physical
. Normal studies of esophagus, stomach and duodenum (particularly in patients over 45)