Summary
Definition
History and exam
Key diagnostic factors
- dor abdominal
- "sinal de apontar"
Other diagnostic factors
- desconforto epigástrico
- náuseas ou vômitos
- saciedade precoce
- perda de peso ou anorexia
- diarreia
- sintomas de anemia
- sangramento gastrointestinal (GI)
- choque hipotenso ou séptico
- som de sucussão
Risk factors
- Infecção por Helicobacter pylori
- uso de anti-inflamatórios não esteroidais (AINEs)
- tabagismo
- idade mais avançada
- história pessoal de úlcera péptica
- história familiar de úlcera péptica
- paciente de terapia intensiva
Diagnostic tests
1st tests to order
- teste respiratório para Helicobacter pylori ou teste do antígeno fecal
- endoscopia digestiva alta
- Hemograma completo
Tests to consider
- nível de gastrina sérica em jejum
- ATG de abdome e pelve, com e sem contraste
- arteriografia visceral
Treatment algorithm
úlcera com sangramento ativo
sem sangramento ativo: Helicobacter pylori negativo
sem sangramento ativo: Helicobacter pylori positivo
recorrências frequentes, úlceras grandes ou refratárias
úlcera associada a anti-inflamatório não esteroidal refratária à terapia de supressão ácida
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, Redhill Pharmaceuticals, and ISOThrive Inc. NM is an 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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Moayyedi PM, Lacy BE, Andrews CN, et al. ACG and CAG clinical guideline: management of dyspepsia. Am J Gastroenterol. 2017 Jul;112(7):988-1013.Full text Abstract
Chey WD, Leontiadis GI, Howden CW, et al. ACG clinical guideline: treatment of Helicobacter pylori infection. Am J Gastroenterol. 2017 Feb;112(2):212-39.Full text Abstract
Laine L, Barkun AN, Saltzman JR, et al. ACG clinical guideline: upper gastrointestinal and ulcer bleeding. Am J Gastroenterol. 2021 May 1;116(5):899-917. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Câncer esofágico
- Câncer de estômago
- Doença do refluxo gastroesofágico (DRGE)
More DifferentialsGuidelines
- ACR appropriateness criteria: nonvariceal upper gastrointestinal bleeding
- ACG clinical guideline: treatment of Helicobacter pylori infection
More GuidelinesPatient information
Úlceras pépticas
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