Hi. Thanks for your query. Noted the history and understood the concerns. Since you have so many problems at an young age of 33 let us consider one by one. Raised acidity leads to ulcer formation and thus deformed pylorus and duodenum. If this is not causing any obstruction to the outflow of food nothing needs to be done. If this is causing symptoms and signs of obstruction, it is better to get operated by bypassing the deformed part. Piles of grade III and IV needs surgical excision. Infective pathology be treated with an appropriate antibiotic cover for long enough to get probable cure. Arthritis needs an opinion of an Orthopedic Surgeon for proper clinical evaluation, examination, investigations and proper management. Thus to get all the problems solved one by one. Keep away from stress an anxiety. Take care. Regards. Dr T Chandrakant.