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Peptic ulcer disease

Última revisão: 20 Aug 2025
Última atualização: 27 Feb 2025

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • abdominal pain
  • "pointing sign"
Detalhes completos

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
Detalhes completos

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
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • Helicobacter pylori urea breath test or stool antigen test
  • upper gastrointestinal endoscopy
  • CBC
Detalhes completos

Tests to avoid

  • Serology
Detalhes completos

Investigações a serem consideradas

  • fasting serum gastrin level
  • CTA abdomen and pelvis without and with contrast
  • arteriography visceral
Detalhes completos

Algoritmo de tratamento

AGUDA

active bleeding ulcer

no active bleeding: Helicobacter pylori negative

no active bleeding: Helicobacter pylori positive

CONTÍNUA

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

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

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.
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