Gastric ulcer
Gastric ulcers that are benign on biopsy but suspicious – biopsy again using ‘drill’ biopsies
Try high does PPI (Omeprazole 40mg BD) and H Pylori eradication (PPI/clarithromycin/metronidazole).
Measure fasting gastrin and serum chromogranin A levels (gastrinoma – ie. Zollinger-Ellison syndrome)
If still not resolving, even if biopsy negative, consider surgery
ZES
High gastric acid level due to to gastrin secreting tumours
Gastrin à parietal cell acid secretion + enterochromaffin-like cell histamine secretion
MEN-1
Surgery = distal gastrectomy + roux-en-Y