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GU Johnson classification 1--angularis incisura 2--1+DU 3--prepyloric 4--hi lesser curve/near EGJ 5--Nsaid induce--anywhere 2/3--acid hypersecretion Nsaid Who need PPI -60yr -Hx of acid/peptic dz -concurrent steroid intake -concurrent anticoag intake -hi-dose Nsaid/ASA EGD ->45 yr -Alarm symp--wt loss,dysphagia, bleeding,anemia,recurrent vomiting
4.Intractable,nonhealing DDx Ca--gastric,pancreatic,duodenum Persistent H.pylori--false-ve Non-compliance ZES DU 1.HSV 2.V+D 3.V+A GU HSV,wedge distal gastrec
-EBV -menetrier dz
Decrease risk -aspirin -vegetable/fruit diet -vit c,e Genetic factor -p53 and COX-2 gene :deletion or suppression of p53 :overexpression of COX-2
3a
3b 4
M1
DDx of hypergastrinemia 1.With excessive gastric acid (ulcerogenic) -Zollinger Ellison syn -GOO -retained gastric antrum (after BillrothII reconstruction ) -G-cell hyperplasia