Summary
Definition
History and exam
Key diagnostic factors
- abdominal pain
- "pointing sign"
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
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
Diagnostic investigations
1st investigations to order
- Helicobacter pylori urea breath test or stool antigen test
- upper gastrointestinal endoscopy
- CBC
Investigations to consider
- fasting serum gastrin level
Treatment algorithm
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
Contributors
Authors
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
Philadelphia
PA
Disclosures
KLL declares that she has no competing interests.
Acknowledgements
Dr Kristle Lynch 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
- ACG and CAG clinical guideline: management of anticoagulants and antiplatelets during acute gastrointestinal bleeding and the periendoscopic period
- ACG clinical guideline: upper gastrointestinal and ulcer bleeding
More GuidelinesPatient leaflets
Peptic ulcers
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