Peptic ulcer disease

Last reviewed: 1 Nov 2022
Last updated: 09 May 2022

Summary

Definition

History and exam

Key diagnostic factors

  • abdominal pain
  • presence of risk factors
  • 'pointing sign'
Full details

Other diagnostic factors

  • epigastric tenderness
  • nausea or vomiting
  • early satiety
  • weight loss or anorexia
  • diarrhoea
  • symptoms of anaemia
  • gastrointestinal bleeding
  • hypotension or septic shock
  • succussion splash
Full details

Risk factors

  • Helicobacter pylori infection
  • non-steroidal anti-inflammatory drug (NSAID) use
  • smoking
  • increasing age
  • personal history of peptic ulcer disease
  • family history of peptic ulcer disease
  • patient in intensive care
Full details

Diagnostic investigations

1st investigations to order

  • upper gastrointestinal endoscopy
  • Helicobacter pylori carbon-13 urea breath test or stool antigen test
  • FBC
Full details

Investigations to consider

  • fasting serum gastrin level
  • urine NSAID screen
Full details

Treatment algorithm

ACUTE

active bleeding ulcer

no active bleeding: Helicobacter pylori negative

no active bleeding: Helicobacter pylori positive

ONGOING

recurrent or refractory ulcers

Contributors

Expert advisers

Ian Beales, BSc, MD, FRCP, FEBG

Consultant Gastroenterologist

Clinical Associate Professor

Norwich Medical School

Department of Gastroenterology

Norfolk and Norwich University Hospital

Norwich

UK

Disclosures

IB declares that he has no competing interests.

Kristle Lee Lynch, MD

Assistant Professor of Clinical Medicine

Division of Gastroenterology

Department of Medicine

Hospital of the University of Pennsylvania

University of Pennsylvania

Perelman School of Medicine

Philadelphia

PA

Disclosures

KLL declares that she has no competing interests.

Acknowledgements

Dr Kristle Lynch would like to gratefully acknowledge Dr Marty M Meyer and Dr Steven Moss, previous contributors to this topic.

Peer reviewers

Alexander C Ford, MBChB, MD, FRCP

Professor of Gastroenterology

Honorary Consultant Gastroenterologist

Leeds Institute of Medical Research at St. James's

University of Leeds

Leeds Gastroenterology Institute

Leeds Teaching Hospitals Trust

Leeds

UK

Biography

ACF served on the National Institute for Health and Care Excellence (NICE) guideline committee for clinical guideline CG184: Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management.

Disclosures

ACF declares that he has no competing interests. ACF is an author of a Cochrane systematic review cited in this topic.

Editors

Celia Pincus

Section Editor, BMJ Best Practice

Disclosures

CP declares that she has no competing interests.

Jo Haynes

Head of Editorial, BMJ Knowledge Centre

Disclosures

JH declares that she has no competing interests.

Adam Mitchell

Drug Editor, BMJ Best Practice

Disclosures

AM declares that he has no competing interests.

Julie Costello

Comorbidities Editor, BMJ Best Practice

Disclosures

JC declares that she has no competing interests.

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