Last reviewed: November 2017
Last updated: November  2017



History and exam

Key diagnostic factors

  • presence of risk factors
  • dyspepsia/epigastric discomfort
  • no suspicious features of malignancy

Other diagnostic factors

  • nausea, vomiting, and loss of appetite
  • severe emesis
  • acute abdominal pain
  • fever
  • altered reflexes or sensory deficits
  • cognitive impairment
  • glossitis
  • co-existing autoimmune disease

Risk factors

  • Helicobacter pylori infection
  • non-steroidal anti-inflammatory drug (NSAID) use
  • alcohol use/toxic ingestions
  • previous gastric surgery
  • critically ill patients
  • autoimmune disease
  • immunocompromise
  • North European or Scandinavian ancestry

Diagnostic investigations

1st investigations to order

  • Helicobacter pylori urea breath test
  • H pylori faecal antigen test
  • FBC
Full details

Investigations to consider

  • endoscopy
  • H pylori rapid urease test
  • gastric mucosal histology
  • serum vitamin B12
  • upper GI contrast series
  • blood/fluid cultures
  • parietal cell antibodies
  • intrinsic factor antibodies
Full details

Emerging tests

  • H pylori culture/PCR
Full details

Treatment algorithm


Authors VIEW ALL

Clinical Associate Professor of Medicine

University of Chicago Pritzker School of Medicine


Medical Director

Center for the Study of Complex Diseases

Research Institute

NorthShore University HealthSystem




EDE declares that he has no competing interests.

Dr Eli D. Ehrenpreis would like to gratefully acknowledge Dr Nicole Marie Gentile, Dr Parakkal Deepak, and Dr Elad Eichenwald, previous contributors to this monograph. NMG, PD, and EE declare that they have no competing interests.

Peer reviewers VIEW ALL

Professor and Consultant Gastroenterologist

Department of Gastroenterology

Leeds General Infirmary




AA is the author of studies referenced in this monograph.

Assistant Professor of Medicine

Section of Gastroenterology and Nutrition

Rush University Medical Center




GS declares that he has no competing interests.

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