Peptic ulcers usually present as chronic, upper abdominal pain related to eating a meal (dyspepsia).
Use of nonsteroidal anti-inflammatory drugs (NSAIDs) and Helicobacter pylori infection are the most common causes.
There may be some epigastric tenderness, but often there are no other signs on physical examination.
Endoscopy is diagnostic and may show an ulcer in the stomach or proximal duodenum. H pylori infection should be sought.
In the absence of "alarm" (red flag) symptoms or signs, testing for and treating H pylori and/or empiric acid inhibition therapy is appropriate.
The most common complication is gastroduodenal bleeding. Perforation is a less frequent but potentially life-threatening complication. Either of these may be the presenting symptom, particularly in patients taking NSAIDs.
A break in the mucosal lining of the stomach or duodenum more than 5 mm in diameter, with depth to the submucosa. Ulcers smaller than this or without obvious depth are called erosions. Peptic ulcers result from an imbalance between factors promoting mucosal damage (gastric acid, pepsin, Helicobacter pylori infection, nonsteroidal anti-inflammatory drug use) and those mechanisms promoting gastroduodenal defense (prostaglandins, mucus, bicarbonate, mucosal blood flow).
History and exam
Kristle Lee Lynch, MD
Assistant Professor of Clinical Medicine
Division of Gastroenterology
Department of Medicine
Hospital of the University of Pennsylvania
University of Pennsylvania
Perelman School of Medicine
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.
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.
Lise Lotte Gluud, MD
Gastrounit Medical Division
Copenhagen University Hospital Hvidovre
LLG declares that she has no competing interests.
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