Tumors of the upper gastrointestinal tract The major benign disease of the upper GI tract area is peptic ulcer; those of the lower GI tract are diverticulosis and mucosal polyp. The malignant disease usually affecting either area is the same—adenocarcinoma. The major clinical symptom of peptic ulcer is epigastric pain that occurs between meals and is relieved by food or antacids. Patients with gastric carcinoma may have similar pain, nonspecific pain, or simple gastric discomfort. The most frequent malignancies arise in the stomach and the head of the pancreas. X-rays. Radiologic procedures include an upper GI series for stomach and duodenum and a barium enema for the colon. In the upper GI series, the patient swallows a barium mixture, and a series of x-ray films shows this radiopaque material filling the stomach and duodenum. Carcinoma of the stomach. Under the best conditions, x-ray examination (upper GI series) is said to be about 90% accurate in detection of gastric carcinoma. However, x-ray examination does not reveal the nature of the lesion. Gastroscopy is currently the best procedure for diagnosis, since instruments that allow visualization of most areas in the stomach and also permit biopsy are available. If gastroscopy is not available, gastric analysis for acid (after stimulation) may be helpful; achlorhydria considerably increases suspicion of carcinoma. Cytology of gastric washings is useful. However, gastric cytology is not as successful as cytology of specimens from uterine or even from pulmonary neoplasia, since small gastric tumors may not shed many neoplastic cells, and interpretation of gastric Papanicolaou smears in general is more difficult. Gastric aspiration specimens for cytology should be placed in ice immediately to preserve the cells.