Last reviewed: 31 Jul 2024
Last updated: 25 Aug 2023
Summary
Definition
History and exam
Key diagnostic factors
- abdominal pain
- "pointing sign"
Full details
Other diagnostic factors
- epigastric tenderness
- nausea or vomiting
- early satiety
- weight loss or anorexia
- diarrhea
- symptoms of anemia
- gastrointestinal (GI) bleeding
- hypotensive or septic shock
- succussion splash
Full details
Risk factors
- Helicobacter pylori infection
- nonsteroidal 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 tests
1st tests to order
- Helicobacter pylori urea breath test or stool antigen test
- upper gastrointestinal endoscopy
- CBC
Full details
Tests to consider
- fasting serum gastrin level
Full details
Treatment algorithm
ACUTE
active bleeding ulcer
no active bleeding: Helicobacter pylori negative
no active bleeding: Helicobacter pylori positive
ONGOING
frequent recurrences, large or refractory ulcers
NSAID-associated ulcer refractory to acid suppression therapy
Contributors
Authors
Nimish Vakil, MD, FACP, AGAF, FASGE, FACG
Clinical Adjunct Professor
School of Medicine and Public Health
University of Wisconsin
Madison
WI
Disclosures
NM is a consultant for Phathom Pharmaceuticals and Redhill Pharmaceuticals, and author of the Merck Manual.
Acknowledgements
The contributors would like to gratefully acknowledge Dr Marty M Meyer and Dr Steven Moss, previous contributors to this topic.
Disclosures
SM is on the speaker's bureau for Otsuka, the manufacturer of Helicobacter pylori breath-test kits. MMM declares that he has no competing interests.
Peer reviewers
Lise Lotte Gluud, MD
Consultant
Gastrounit Medical Division
Copenhagen University Hospital Hvidovre
Copenhagen
Denmark
Disclosures
LLG declares that she has no competing interests.
Differentials
- Esophageal cancer
- Stomach cancer
- Gastroesophageal reflux disease (GERD)
More DifferentialsGuidelines
- CDC Yellow Book: health information for international travel - Helicobacter pylori
- Current concepts in the management of Helicobacter pylori infection: the Maastricht VI/Florence Consensus Report
More GuidelinesPatient information
Peptic ulcers
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