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Úlcera péptica

Last reviewed: 6 Aug 2025
Last updated: 27 Feb 2025

Summary

Definition

History and exam

Key diagnostic factors

  • dor abdominal
  • "sinal de apontar"
Full details

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
Full details

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
Full details

Diagnostic tests

1st tests to order

  • teste respiratório para Helicobacter pylori ou teste do antígeno fecal
  • endoscopia digestiva alta
  • Hemograma completo
Full details

Tests to consider

  • nível de gastrina sérica em jejum
  • ATG de abdome e pelve, com e sem contraste
  • arteriografia visceral
Full details

Treatment algorithm

ACUTE

úlcera com sangramento ativo

sem sangramento ativo: Helicobacter pylori negativo

sem sangramento ativo: Helicobacter pylori positivo

ONGOING

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

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

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

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  • Guidelines

    • ACR appropriateness criteria: nonvariceal upper gastrointestinal bleeding
    • ACG clinical guideline: treatment of Helicobacter pylori infection
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  • Patient information

    Úlceras pépticas

    More Patient information
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