Summary

• Usually presents as chronic, upper abdominal pain related to eating a meal (dyspepsia).
• Use of nonsteroidal anti-inflammatory drugs (NSAIDs) and Helicobacter pylori infection are the most common causes.
• There may be some epigastric tenderness, but often there are no other signs on physical examination.
• Endoscopy is diagnostic and may show an ulcer in the stomach or proximal duodenum. H pylori infection should be sought.
• In the absence of "alarm" (red flag) symptoms or signs, testing for and treating H pylori and/or empirical acid inhibition therapy is appropriate.
• Most common complications are gastroduodenal bleeding and perforation, either of which may be the presenting symptom, particularly in patients taking NSAIDs.