Last reviewed: 19 Sep 2021
Last updated: 12 Mar 2020



History and exam

Key diagnostic 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
  • coexisting autoimmune disease

Risk factors

  • Helicobacter pylori infection
  • nonsteroidal 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 fecal antigen test
  • CBC

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

Emerging tests

  • H pylori culture/polymerase chain reaction (PCR)

Treatment algorithm



Eli D. Ehrenpreis, MD, FACG, AGAF

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


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

Anthony Axon, MB, BS, MD, FRCP

Professor and Consultant Gastroenterologist

Department of Gastroenterology

Leeds General Infirmary




AA is the author of studies referenced in this topic.

Garth Swanson, MD

Assistant Professor of Medicine

Section of Gastroenterology and Nutrition

Rush University Medical Center




GS declares that he has no competing interests.

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