Last reviewed: 14 Apr 2021
Last updated: 11 Dec 2020

Summary

Definition

History and exam

Key diagnostic factors

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

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

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

Diagnostic investigations

1st investigations to order

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

Investigations to consider

  • fasting serum gastrin level
  • urine NSAID screen

Treatment algorithm

Contributors

Expert advisersVIEW ALL

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. 

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

Peer reviewersVIEW ALL

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.

Section Editor, BMJ Best Practice

Disclosures

CP declares that she has no competing interests.

Head of Editorial, BMJ Knowledge Centre

Disclosures

JH declares that she has no competing interests.

Drug Editor, BMJ Best Practice

Disclosures

AM declares that he has no competing interests.

Comorbidities Editor, BMJ Best Practice

Disclosures

JC declares that she has no competing interests.

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