Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- abdominal pain
- "pointing sign"
Outros fatores diagnósticos
- epigastric tenderness
- nausea or vomiting
- early satiety
- weight loss or anorexia
- diarrhea
- symptoms of anemia
- gastrointestinal (GI) bleeding
- hypotensive or septic shock
- succussion splash
Fatores de risco
- 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
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- Helicobacter pylori urea breath test or stool antigen test
- upper gastrointestinal endoscopy
- CBC
Tests to avoid
- Serology
Investigações a serem consideradas
- fasting serum gastrin level
- CTA abdomen and pelvis without and with contrast
- arteriography visceral
Algoritmo de tratamento
active bleeding ulcer
no active bleeding: Helicobacter pylori negative
no active bleeding: Helicobacter pylori positive
frequent recurrences, large or refractory ulcers
NSAID-associated ulcer refractory to acid suppression therapy
Colaboradores
Autores
Nimish Vakil, MD, FACP, AGAF, FASGE, FACG
Clinical Adjunct Professor
School of Medicine and Public Health
University of Wisconsin
Madison
WI
Declarações
NM is a consultant for Phathom Pharmaceuticals, Redhill Pharmaceuticals, and ISOThrive Inc. NM is an author of the Merck Manual.
Agradecimentos
The contributors would like to gratefully acknowledge Dr Marty M Meyer and Dr Steven Moss, previous contributors to this topic.
Declarações
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.
Revisores
Lise Lotte Gluud, MD
Consultant
Gastrounit Medical Division
Copenhagen University Hospital Hvidovre
Copenhagen
Denmark
Declarações
LLG declares that she has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Referências
Principais artigos
Moayyedi PM, Lacy BE, Andrews CN, et al. ACG and CAG clinical guideline: management of dyspepsia. Am J Gastroenterol. 2017 Jul;112(7):988-1013.Texto completo Resumo
Chey WD, Leontiadis GI, Howden CW, et al. ACG clinical guideline: treatment of Helicobacter pylori infection. Am J Gastroenterol. 2017 Feb;112(2):212-39.Texto completo Resumo
Laine L, Barkun AN, Saltzman JR, et al. ACG clinical guideline: upper gastrointestinal and ulcer bleeding. Am J Gastroenterol. 2021 May 1;116(5):899-917. Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Esophageal cancer
- Stomach cancer
- Gastroesophageal reflux disease (GERD)
Mais Diagnósticos diferenciaisDiretrizes
- ACR appropriateness criteria: nonvariceal upper gastrointestinal bleeding
- ACG clinical guideline: treatment of Helicobacter pylori infection
Mais DiretrizesFolhetos informativos para os pacientes
Peptic ulcers
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