Peptic ulcer disease

Last reviewed: 6 Sep 2022
Last updated: 10 Sep 2020

Summary

Definition

History and exam

Key diagnostic factors

  • abdominal pain
  • pointing sign
More key diagnostic factors

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
Other diagnostic factors

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
More risk factors

Diagnostic investigations

1st investigations to order

  • Helicobacter pylori urea breath test or stool antigen test
  • upper gastrointestinal endoscopy
  • CBC
More 1st investigations to order

Investigations to consider

  • fasting serum gastrin level
More investigations to consider

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

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 Differentials
  • Guidelines

    • Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management
    • Helicobacter pylori in dyspepsia: test and treat
    More Guidelines
  • Patient leaflets

    Peptic ulcers

    More Patient leaflets
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer