Differentials
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MaagklachtenPublished by: NHGLast published: 2025Peptic ulcer disease (PUD)
SIGNS / SYMPTOMS
Clinical signs and symptoms (e.g., epigastric abdominal pain, dyspepsia, nausea, bloating, and early satiety) may be similar.
INVESTIGATIONS
Peptic ulcer disease is strongly associated with Helicobacter pylori infection and non-steroidal anti-inflammatory drugs (NSAIDs) use.[3]
Faecal occult blood test (e.g., faecal immunochemical 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 (e.g., epigastric abdominal pain, dyspepsia, nausea, bloating, and early satiety) may be similar.
GORD is characterised by specific oesophageal and extra-oesophageal symptoms such as chronic cough, globus, asthma, and laryngitis.[55]
INVESTIGATIONS
Helicobacter pylori urea breath test is negative.
Endoscopy and oesophageal histology show oesophageal involvement.
Non-ulcer dyspepsia
SIGNS / SYMPTOMS
Clinical signs and symptoms (e.g., epigastric abdominal pain, dyspepsia, nausea, bloating, and early satiety) may be similar to symptomatic gastritis and peptic ulcer disease.
Gastric lymphoma
SIGNS / SYMPTOMS
Clinical signs and symptoms (e.g., epigastric abdominal pain, dyspepsia, nausea, bloating, and early satiety) may be similar.
INVESTIGATIONS
Gastric mucosa-associated lymphoid tissue (MALT) lymphoma is strongly associated with Helicobacter pylori infection.[3][22] Faecal occult blood test may be positive, indicating occult gastrointestinal 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).
INVESTIGATIONS
Gastric adenocarcinoma is strongly associated with Helicobacter pylori infection and chronic gastritis.[3]
Endoscopy shows gastric mass or irregular ulcer.[41] Image-enhanced endoscopy is considered the best imaging method to risk-stratify and detect gastric atrophy and/or gastric intestinal metaplasia, which are both stages of progression of gastric carcinoma.[56]
Five to six biopsies of a gastric mass are required to increase sensitivity.[57]
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