小结
定义
病史和体格检查
关键诊断因素
- 腹痛
- 存在的危险因素
- 指点征
其他诊断因素
- 上腹部压痛
- 恶心或呕吐
- 早饱感
- 体重减轻或厌食
- 腹泻
- 贫血的症状
- 胃肠道出血
- 低血压或脓毒性休克
- 振水音
危险因素
- 幽门螺杆菌感染
- 使用非甾体抗炎药 (NSAID)
- 吸烟
- 年龄增长
- 消化性溃疡病患者的个人史
- 消化性溃疡病患者的家族史
- 重症监护病房患者
诊断性检查
首要检查
- 上消化道内镜检查
- 幽门螺杆菌碳-13 尿素呼气试验或粪便抗原检测
- 全血细胞计数 (FBC）
需考虑的检查
- 空腹血清胃泌素水平
- 尿液 NSAID 筛查
治疗流程
活动性出血性溃疡
非活动性出血：幽门螺杆菌阴性
非活动性出血：幽门螺杆菌阳性
复发性或难治性溃疡
撰稿人
专家顾问
Ian Beales, BSc, MD, FRCP, FEBG
Consultant Gastroenterologist
Clinical Associate Professor
Norwich Medical School
Department of Gastroenterology
Norfolk and Norwich University Hospital
Norwich
UK
利益声明
IB declares that he has no competing interests.
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
利益声明
KLL declares that she has no competing interests.
鸣谢
Dr Kristle Lynch would like to gratefully acknowledge Dr Marty M Meyer and Dr Steven Moss, previous contributors to this topic.
同行评议者
Alexander C Ford, MBChB, MD, FRCP
Professor of Gastroenterology
Honorary Consultant Gastroenterologist
Leeds Institute of Medical Research at St. James's
University of Leeds
Leeds Gastroenterology Institute
Leeds Teaching Hospitals Trust
Leeds
UK
简介
ACF served on the National Institute for Health and Care Excellence (NICE) guideline committee for clinical guideline CG184: Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management.
利益声明
ACF declares that he has no competing interests. ACF is an author of a Cochrane systematic review cited in this topic.
编辑
Celia Pincus
Section Editor, BMJ Best Practice
利益声明
CP declares that she has no competing interests.
Jo Haynes
Head of Editorial, BMJ Knowledge Centre
利益声明
JH declares that she has no competing interests.
Adam Mitchell
Drug Editor, BMJ Best Practice
利益声明
AM declares that he has no competing interests.
Julie Costello
Comorbidities Editor, BMJ Best Practice
利益声明
JC declares that she has no competing interests.
鉴别诊断
- 食管癌
- 胃癌
- 胃食管反流病 (GORD)
更多 鉴别诊断指南
- 成人胃食管反流病和消化不良：检查与管理
- 16 岁以上人群急性上消化道出血：管理
更多 指南医学计算器
胃肠道出血的 Blatchford 评分
上消化道出血的 Rockall 评分
更多 医学计算器患者教育信息
消化性溃疡
更多 患者教育信息
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