Last reviewed: September 2018
Last updated: October  2018

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • dyspepsia/epigastric discomfort
  • no suspicious features of malignancy

Other diagnostic factors

  • nausea, vomiting, and loss of appetite
  • severe emesis
  • acute abdominal pain
  • fever
  • altered reflexes or sensory deficits
  • cognitive impairment
  • glossitis
  • co-existing autoimmune disease

Risk factors

  • Helicobacter pylori infection
  • non-steroidal anti-inflammatory drug (NSAID) use
  • alcohol use/toxic ingestions
  • previous gastric surgery
  • critically ill patients
  • autoimmune disease
  • immunocompromise
  • North European or Scandinavian ancestry

Diagnostic investigations

1st investigations to order

  • Helicobacter pylori urea breath test
  • H pylori faecal antigen test
  • FBC
Full details

Investigations to consider

  • endoscopy
  • H pylori rapid urease test
  • gastric mucosal histology
  • serum vitamin B12
  • upper GI contrast series
  • blood/fluid cultures
  • parietal cell antibodies
  • intrinsic factor antibodies
Full details

Emerging tests

  • H pylori culture/polymerase chain reaction (PCR)
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Professor of Medicine

Rosalind Franklin University Medical School

North Chicago, Illinois

Adjunct Professor of Pediatric Gastroenterology

University of Miami Miller Medical School

Miami, Florida

Associate Director for Research

Internal Medicine Residency

Advocate Lutheran General Hospital

Park Ridge, Illinois

Disclosures

EDE declares that he is a consultant for Pediatric Pharmaceuticals

Dr Eli D. Ehrenpreis would like to gratefully acknowledge Dr Nicole Marie Gentile, Dr Parakkal Deepak, and Dr Elad Eichenwald, previous contributors to this topic. NMG, PD, and EE declare that they have no competing interests.

Peer reviewers VIEW ALL

Professor and Consultant Gastroenterologist

Department of Gastroenterology

Leeds General Infirmary

Leeds

UK

Disclosures

AA is the author of studies referenced in this topic.

Assistant Professor of Medicine

Section of Gastroenterology and Nutrition

Rush University Medical Center

Chicago

IL

Disclosures

GS declares that he has no competing interests.

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