小结
定义
病史和体格检查
关键诊断因素
- 腹痛
- 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
- 消化道出血
- 低血压性或脓毒性休克
- 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
- 年龄较大
- 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
- 幽门螺杆菌尿素呼气试验或粪便抗原检测
- 上消化道内镜检查
- 全血细胞计数（FBC）
需考虑的检查
- 空腹血清胃泌素水平
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
反复发作、面积大或难治性溃疡
抑酸治疗效果较差的 NSAID 相关性溃疡。
撰稿人
作者
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.
利益声明
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.
同行评议者
Lise Lotte Gluud, MD
Consultant
Gastrounit Medical Division
Copenhagen University Hospital Hvidovre
Copenhagen
Denmark
利益声明
LLG declares that she has no competing interests.
参考文献
关键文献
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.全文 摘要
National Institute for Health and Care Excellence. Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management. September 2019 [internet publication].全文
Laine L, Jensen DM. Management of patients with ulcer bleeding. Am J Gastroenterol. 2012 Mar;107(3):345-60全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- 食管癌
- 胃癌
- 胃食管反流病 (GORD)
更多 鉴别诊断指南
- 存在幽门螺杆菌的消化不良：检查和治疗
- CDC 国际旅行健康信息（黄皮书）：幽门螺杆菌
更多 指南患者教育信息
Peptic ulcers
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