Gastric disease

GERD: PPI + lifestyle modification

Barret: GERD --> squamous ->columnar, repeat endoscopy 2-3years, endoscopy if GERD>5 years or alarm symptoms

Ulcer: usually nontender, Dx: endoscopy,
gastric: pain on eating, weight loss
duodendal: pain relieving on eating,
H. Pylori: serology, breath urea test, stool antigen. the latter two are used to test therapy effect
NSAID ulcer: misoprostol
Cox-2: celecoxib, valdecoxib

Gastritis: asymptomatic bleeding, type A gastritis: gastric mucosa atrophy, vitB12 deficiency, increased gastrin, MALT

Zollinger-Ellison syndrome: duodenum and pancreas gastrinomas, MEN I.
ulcer + diarrhea + metastasis
Dx: increased gastrin when off anti-acid treatment, concurrent rise of acid and gastrin, positive secretin stimulate test, then US, CT, MRI, somatostatin scintigraphy to exclude metastasis
Txt: surgery, PPI for metastasis

Gastroparesis: fullness, diabetes Dx: clinical Txt: erythromycin or metoclopramide

Nonulcer dyspepsia: rule out all other disease, treat H. Pylori if has.