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__NOTOC__
{{Infobox_Disease |
{{Infobox_Disease |
   Name          = {{PAGENAME}} |
   Name          = {{PAGENAME}} |
   Image          = Deep gastric ulcer.png |
   Image          = Deep gastric ulcer.png |
   Caption        = Deep gastric ulcer |
   Caption        = Deep gastric ulcer |
  DiseasesDB    = 9819 |
  ICD10          = {{ICD10|K|25||k|20}}-{{ICD10|K|27||k|20}} |
  ICD9          = {{ICD9|531}}-{{ICD9|534}} |
  ICDO          = |
  OMIM          = |
  MedlinePlus    = |
  eMedicineSubj  = |
  eMedicineTopic = |
  eMedicine_mult = |
  MeshID        = D010437 |
}}  
}}  
{{Peptic ulcer}}
{{Peptic ulcer}}
'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''


{{CMG}}
{{CMG}} ; {{AE}} {{MKK}}  


==Overview==
{{SK}} Gastroduodenal ulcers; Peptic ulceration; gastric ulcer; duodenal ulcer.


== Epidemiology ==
==[[Peptic ulcer overview|Overview]]==


==History==
==[[Peptic ulcer historical perspective|Historical Perspective]]==


==Classification==
==[[Peptic ulcer classification|Classification]]==


== Pathophysiology ==


== Diagnosis ==
==[[Peptic ulcer pathophysiology|Pathophysiology]]==
The diagnosis of ''[[Helicobacter pylori]]'' can be by:
*Breath testing (does not require EGD);
*Direct culture from an EGD biopsy specimen;
*Direct detection of [[urease]] activity in a biopsy specimen;
*Measurement of [[antibody]] levels in [[blood]] (does not require EGD). It is still somewhat controversial whether a positive antibody without EGD is enough to warrant eradication therapy.


The possibility of other causes of ulcers, notably [[malignancy]] ([[gastric cancer]]) needs to be kept in mind. This is especially true in ulcers of the ''greater (large) curvature'' of the [[stomach]]; most are also a consequence of chronic ''H. pylori'' infection.
==[[Peptic ulcer causes|Causes]]==


== Differential Diagnosis ==
==[[Peptic ulcer differential diagnosis|Differentiating Peptic ulcer from other Diseases]]==
*Alcohol
*[[Alpha-1 Antitrypsin Deficiency]]
*Basophilic leukemia
*[[Burn]]s
*Cerebral [[trauma]]
*Chronic debilitated conditions
*[[Chronic obstructive pulmonary disease]]
*[[Chronic Renal Failure]]
*Cigarette smoking
*[[Cirrhosis]]
*[[Cystic Fibrosis]]
*Glucosteroids
*[[Helicobacter pylori infection]]
*[[Hyperparathyroidism]]
*Incompetant gastroesophageal sphincter
*[[NSAID]]s
*Severe systemic disease
*[[Zollinger-Ellison Syndrome]]


==Treatment==
==[[Peptic ulcer epidemiology and demographics|Epidemiology and Demographics]]==


Younger patients with ulcer-like symptoms are often treated with [[antacid]]s or [[H2 antagonist]]s before EGD is undertaken. [[Bismuth subsalicylate|Bismuth compounds]] may actually reduce or even clear organisms.
==[[Peptic ulcer risk factors|Risk Factors]]==


Patients who are taking [[NSAIDs|nonsteroidal anti-inflammatories]] (NSAIDs) may also be prescribed a [[prostaglandin]] [[analog (chemistry)|analogue]] ([[Misoprostol]]) in order to help prevent peptic ulcers, which may be a side-effect of the NSAIDs.
==[[Peptic ulcer screening|Screening]]==


When ''H. pylori'' infection is present, the most effective treatments are combinations of 2 antibiotics (e.g. [[Erythromycin]], [[Ampicillin]], [[Amoxicillin]], [[Tetracycline]], [[Metronidazole]]) and 1 [[proton pump inhibitor]] (PPI). An effective combination would be [[Amoxicillin]] + [[Metronidazole]] + [[Pantoprazole]] (a PPI). In the absence of ''H. pylori'', long-term higher dose PPIs are often used.
==[[Peptic ulcer natural history|Natural History, Complications and Prognosis]]==


Treatment of ''H. pylori'' usually leads to clearing of infection, relief of symptoms and eventual healing of ulcers. Recurrence of infection can occur and retreatment may be required, if necessary with other antibiotics. Since the widespread use of PPI's in the 1990s, surgical procedures (like "highly selective [[vagotomy]]") for uncomplicated peptic ulcers  became obsolete.
==[[Peptic ulcer diagnosis|Diagnosis]]==
[[Peptic ulcer history and symptoms|History and Symptoms]] | [[Peptic ulcer physical examination|Physical Examination]] | [[Peptic ulcer Echocardiogram|Echocardiogram]] | [[Peptic ulcer laboratory tests|Laboratory Findings]] | [[Peptic ulcer x ray| X Ray]] | [[Peptic ulcer CT|CT]] | [[Peptic ulcer ultrasound|Ultrasound]] | [[Peptic ulcer other imaging findings|Other Imaging Findings]] | [[Peptic ulcer other diagnostic studies|Other Diagnostic Studies]]


Perforated peptic ulcer is a surgical emergency and requires surgical repair of the perforation. Most bleeding ulcers require endoscopy urgently to stop bleeding with cauterizations or injection.
==Treatment==
 
[[Peptic ulcer medical therapy|Medical Therapy]] | [[Peptic ulcer surgery|Surgery]] | [[Peptic ulcer primary prevention|Primary Prevention]] | [[Peptic ulcer secondary prevention|Secondary Prevention]] | [[Peptic ulcer cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Peptic ulcer future or investigational therapies|Future or Investigational Therapies]]
==Complications==
==Case Studies==
 
[[Peptic ulcer case study one|Case #1]]
*'''[[Upper gastrointestinal bleeding|Gastrointestinal bleeding]]''' is the commonest complication. Sudden large bleeding can be life threatening<ref name="pmid9391242">{{cite journal |author=Cullen DJ, Hawkey GM, Greenwood DC, ''et al'' |title=Peptic ulcer bleeding in the elderly: relative roles of Helicobacter pylori and non-steroidal anti-inflammatory drugs |journal=Gut |volume=41 |issue=4 |pages=459–62 |year=1997 |pmid=9391242 |doi=}}</ref>. It occurs when the ulcer erodes one of the blood vessels.
*'''Perforation''' (a hole in the wall) often leads to catastrophic consequences. Erosion of the gastro-intestinal wall  by the ulcer leads to spillage of stomach or intestinal content into abdominal cavity. Perforation  at the anterior surface of stomach  leads to acute [[peritonitis]], initially chemical and later bacterial peritonitis. Often first sign is sudden intense abdominal pain. Posterior wall perforation leads to [[pancreatitis]]; pain in this situation often radiates to back.
*'''Penetration''' is when the ulcer continues into adjacent organs such as liver and [[pancreas]]<ref>{{cite web |url=http://www.merck.com/mmhe/sec09/ch121/ch121c.html |title=Peptic Ulcer: Peptic Disorders: Merck Manual Home Edition |accessdate=2007-10-10 |format= |work=}}</ref>.
*Scarring and swelling due to ulcers causes narrowing in the duodenum and '''[[gastric outlet obstruction]]'''. Patient often presents with severe vomiting.


==References==
{{reflist|2}}
== External links ==
*[http://www.pathologyatlas.ro/Peptic%20ulcer.html Pathology specimen of Gastric ulcer]
*[http://www.surgeons.org.uk/general-surgery/perforated-duodenal-ulceration.html A case report and tutorial on perforated duodenal ulcer]
*[http://www.peptic-ulcers.co.uk/causes.html Causes of Peptic ulcers]
{{SIB}}
{{Gastroenterology}}
{{Gastroenterology}}
[[Category:Gastroenterology]]
[[Category:Abdominal pain]]
[[bs:Ulcerozne lezije želuca]]
[[bs:Ulcerozne lezije želuca]]
[[ca:Úlcera pèptica]]
[[ca:Úlcera pèptica]]
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Latest revision as of 23:37, 29 July 2020

Peptic ulcer
Deep gastric ulcer

Peptic ulcer Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Peptic Ulcer from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Upper GI Endoscopy

X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Endoscopic management
Surgical management

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

2017 ACG Guidelines for Peptic Ulcer Disease

Guidelines for the Indications to Test for, and to Treat, H. pylori Infection

Guidelines for First line Treatment Strategies of Peptic Ulcer Disease for Providers in North America

Guidlines for factors that predict the successful eradication when treating H. pylori infection

Guidelines to document H. pylori antimicrobial resistance in the North America

Guidelines for evaluation and testing of H. pylori antibiotic resistance

Guidelines for when to test for treatment success after H. pylori eradication therapy

Guidelines for penicillin allergy in patients with H. pylori infection

Guidelines for the salvage therapy

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to Hospitals Treating Peptic ulcer

Risk calculators and risk factors for Peptic ulcer

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]

Synonyms and keywords: Gastroduodenal ulcers; Peptic ulceration; gastric ulcer; duodenal ulcer.

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Peptic ulcer from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Echocardiogram | Laboratory Findings | X Ray | CT | Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1

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