Differential Diagnosis

Peptic Ulcer Disease

Peptic ulcer disease is ulcer of an area of the gastrointestinal tract that is usually acidic and thus
extremely painful. It is defined as mucosal erosions equal to or greater than 0.5 cm
1
. Evidence of
GI bleeding, weight loss, early satiety, a palpable mass or lymphadenopathy, jaundice,
progressive dysphagia, recurrent vomiting, a family history of cancer, or onset of symptoms after
age 55 years increases the likelihood of Gastric carcinoma
2
. It can be distinguished from gastric
neoplasm by endoscopy and biopsy. All peptic ulcers should have repeat endoscopy after
treatment to document healing.

Achalasia
Achalasia is primarily a disorder of motility of the lower oesophageal or cardiac sphincter.
Suspect malignancy in patients with symptoms for less than 6 months, presentation after age 60
years, and excessive weight loss relative to the duration of symptoms. Distinguished from gastric
neoplasm by manometry, endoscopy, and biopsy
3
.

Gastric polyps
Gastric polyps from gastric epithelial benign tumor can occur at any age, but the more common
60 to 70 years. Small adenoma may have no symptoms, the greater can cause upper abdominal
discomfort, nausea and pain. Adenoma mucosal surface but also erosion, bleeding ulcers caused
by melena, clinical manifestations may resemble gastric cancer
4
. X-ray barium meal examination
showed about 1cm in diameter to the boundary circle complete filling defect, pedunculated
adenomas can push the moving parts. Gastric adenoma and protruded type early gastric cancer
often confused, endoscopic biopsy should be confirmed.

Gastric smooth muscle tumor
Gastric smooth muscle tumors can occur at any age, more common in 50 years of age. The tumor
is more than a single hair, 2 -4cm size, occur in the gastric antrum and gastric body, were round
or oval, patients often have abdominal discomfort,or pain, lack of blood supply to cancer
increases when ulcers can also occur when the intermittent vomiting blood or black stools, about
2% of the hateful become leiomyosarcoma. Gastroscopy with gastric cancer to distinguish, but
the decision is difficult to leiomyoma or a leiomyosarcoma
5
.

Primary malignant lymphoma
Primary malignant lymphoma of the stomach cancer accounted for 0.5% to 8%. More common
in young adults, occur in the antrum, pylorus and lesser curvature before the District. Lesion
from the submucosa of the lymphoid tissue which may extend to involve the stomach around the
entire floor, the Ministry of serous or mucous membrane lesions often incomplete. When the
infiltration of mucosal lesions 40% to 80%, the occurrence of different sizes, different shades of
the ulcer. Clinical manifestations of abdominal fullness, pain, nausea, vomiting, melena,
decreased appetite, weight loss, fatigue, anemia and other non-specific symptoms, ethanol-
induced gastric lymphoma often occurs in patients with abdominal pain, a little itching in
patients with systemic disease. X-ray barium meal examination performance rate of lesions up to
93% to 100%, but can be diagnosed with gastric lymphosarcoma in only about 10%

Benign esophageal stricture
Benign esophageal stricture is a narrowing or tightening of the esophagus that causes swallowing
difficulties. May have a history of gastroesophageal reflux disease. It distinguished from gastric
cancer by endoscopy and biopsy
2
.

1. Neal E. Flomenbaum, MD. GI Consult: Perforated Peptic Ulcer. Emergency Medicine. 2007-
08-26.
2. Talley NJ. American Gastroenterological Association medical position statement: evaluation
of dyspepsia. Gastroenterology. 2005;129:1753-1755.
3. Tracey JP, Traube M. Difficulties in the diagnosis of pseudoachalasia. Am J Gastroenterol.
2006; 89:2014-2018.
4. Morais DJ, Yamanaka A, Zeitun JM, et al. Gastric polyps: a retrospective analysis of 26,000
digestive endoscopies. Arq Gastroenterol 2007;44:14e17.

5.Miettinen M, Furlong M, Sarlomo-Rikala M, Burke A, Sobin LH, Lasota J. Gastrointestinal
stromal tumors, intramural leiomyomas, and leiomyosarcomas in the rectum and anus: a
clinicopathologic, immunohistochemical and molecular genetic study of 144 cases. Am J Surg
Pathol. 2001;25:11211133.