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Peptic ulcer disease

Last reviewed: 9 Nov 2024
Last updated: 10 Oct 2024

Summary

Definition

History and exam

Key diagnostic factors

  • abdominal pain
  • "pointing sign"
Full details

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
Full details

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
Full details

Diagnostic tests

1st tests to order

  • Helicobacter pylori urea breath test or stool antigen test
  • upper gastrointestinal endoscopy
  • CBC
Full details

Tests to avoid

  • Serology
Full details

Tests to consider

  • fasting serum gastrin level
Full details

Treatment algorithm

ACUTE

active bleeding ulcer

no active bleeding: Helicobacter pylori negative

no active bleeding: Helicobacter pylori positive

ONGOING

frequent recurrences, large or refractory ulcers

NSAID-associated ulcer refractory to acid suppression therapy

Contributors

Authors

Nimish Vakil, MD, FACP, AGAF, FASGE, FACG

Clinical Adjunct Professor

School of Medicine and Public Health

University of Wisconsin

Madison

WI

Disclosures

NM is a consultant for Phathom Pharmaceuticals and Redhill Pharmaceuticals, and author of the Merck Manual.

Acknowledgements

The contributors 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 Differentials
  • Guidelines

    • CDC Yellow Book: health information for international travel - Helicobacter pylori
    • Current concepts in the management of Helicobacter pylori infection: the Maastricht VI/Florence Consensus Report
    More Guidelines
  • Patient information

    Peptic ulcers

    More Patient information
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