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{{Peptic ulcer}}
{{Peptic ulcer}}
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{{CMG}} ;{{AE}} {{MKK}}
{{CMG}} ;{{AE}} {{MKK}}
==Overview==
==Overview==
Endoscopy is helpful in the diagnosis of peptic ulcer disease.[[Endoscopy]] with [[biopsy]] is recommended to diagnose [[cancer]] in patients 55 years or older, or with one or more alarm symptoms such as unexplained [[weight loss]], progressive [[dysphagia]], [[odynophagia]], recurrent [[vomiting]], family history of [[gastrointestinal cancer]], overt [[gastrointestinal bleeding]], [[abdominal mass]], [[iron deficiency anemia]].
==Peptic ulcer esophagogastroduodenoscopy==
==Peptic ulcer esophagogastroduodenoscopy==
American College of Gastroenterology (ACG) guidelines 2017 for the treatment of H pylori infection (HPI) include the following recommendations for testing for H pylori:<ref name="urlwww.nature.com">{{cite web |url=https://www.nature.com/ajg/journal/v112/n2/pdf/ajg2016563a.pdf |title=www.nature.com |format= |work= |accessdate=}}</ref>
According to American College of Gastroenterology (ACG) guidelines 2017 for the treatment of [[H pylori]] infection (HPI) include the following recommendations for testing for [[H pylori]]:<ref name="urlwww.nature.com"><nowiki>{{cite web |url=</nowiki>https://www.nature.com/ajg/journal/v112/n2/pdf/ajg2016563a.pdf |title=www.nature.com |format= |work= |accessdat</ref>
*Active or past history of peptic ulcer disease.  
*Active or past history of [[peptic ulcer disease]]  
*Low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma
*Low-grade gastric [[Mucosa-associated lymphoid tissue lymphoma|mucosa-associated lymphoid tissue lymphoma]]([[MALT]])
*Confirmed history of PUD (not previously treated for H. pylori)
*Long-term therapy with Non-steroidal anti-inflammatory agents ([[NSAIDs]]) and low-dose [[aspirin]]
*Long-term therapy with nonsteroidal anti-inflammatory agents (NSAIDs) and low-dose aspirin
*Unexplained [[iron deficiency anemia]] following standard workup
*Unexplained iron deficiency anemia following standard workup
*[[Idiopathic thrombocytopenic purpura]]
*Idiopathic thrombocytopenic purpura
===Pre-endoscopic medical therapy===
===Pre-endoscopic medical therapy===
*Intravenous infusion of erythromycin 250 mg,30 min before endoscopy) can be given to improve diagnostic yield and decrease the need for repeat endoscopy
*Intravenous infusion of [[erythromycin]] 250 mg,30 min before [[endoscopy]]  improve diagnostic yield and decrease the need for repeat [[endoscopy]]
*Intravenous PPI  80 mg bolus followed by 8 mg/h infusion can be given to decrease the number of patients who have higher risk of bleeding at endoscopy
*Intravenous [[PPI]] 80 mg bolus followed by 8 mg/h infusion decreases the number of patients who have higher risk of [[bleeding]] at [[endoscopy]]<ref name="urlManagement of Patients with Ulcer Bleeding | American College of Gastroenterology">{{cite web |url=https://gi.org/guideline/management-of-patients-with-ulcer-bleeding/ |title=Management of Patients with Ulcer Bleeding &#124; American College of Gastroenterology |format= |work= |accessdate=}}</ref>
<ref name="urlManagement of Patients with Ulcer Bleeding | American College of Gastroenterology">{{cite web |url=https://gi.org/guideline/management-of-patients-with-ulcer-bleeding/ |title=Management of Patients with Ulcer Bleeding &#124; American College of Gastroenterology |format= |work= |accessdate=}}</ref>
====Timing of endoscopy====
*Patients with [[bleeding]] [[ulcer]] should undergo [[endoscopy]] within 24 h of admission, following resuscitative efforts to stabilize hemodynamically 
*Hemodynamically stable  patients ,[[endoscopy]] should be performed early and discharged on the same day
*Patients with unstable signs and symptoms  e.g [[tachycardia]], [[hypotension]], bloody emesis or nasogastric aspirate in the hospital [[endoscopy]] should be done within 12 hours
==== Different endoscopic test:====
*[[Endoscopy]] with [[biopsy]] is recommended to diagnose [[cancer]] in patients 55 years or older, or with one or more alarm symptoms such as unexplained [[weight loss]], progressive [[dysphagia]], [[odynophagia]], recurrent [[vomiting]], family history of [[gastrointestinal cancer]], overt [[gastrointestinal bleeding]], [[abdominal mass]], [[iron deficiency anemia]], or [[jaundice]]<ref name="pmid17024539">{{cite journal |vauthors=Bowrey DJ, Griffin SM, Wayman J, Karat D, Hayes N, Raimes SA |title=Use of alarm symptoms to select dyspeptics for endoscopy causes patients with curable esophagogastric cancer to be overlooked |journal=Surg Endosc |volume=20 |issue=11 |pages=1725–8 |year=2006 |pmid=17024539 |doi=10.1007/s00464-005-0679-3 |url=}}</ref>
*The [[rapid urease test]] performed on the biopsy specimen on patients who have not been taking a PPI within one to two weeks or  bismuth or an antibiotic within four weeks of endoscopy
*Culture and [[polymerase chain reaction]] allows for susceptibility testing <ref name="urlManagement of Patients with Ulcer Bleeding | American College of Gastroenterology2">{{cite web |url=https://gi.org/guideline/management-of-patients-with-ulcer-bleeding/ |title=Management of Patients with Ulcer Bleeding &#124; American College of Gastroenterology |format= |work= |accessdate=}}</ref><ref name="pmid24423677">{{cite journal |vauthors=Girdalidze AM, Elisabedashvili GV, Sharvadze LG, Dzhorbenadze TA |title=[Comparative diagnostic value of Helicobacter pylori infection testing methods] |language=Russian |journal=Georgian Med News |volume= |issue=225 |pages=53–60 |year=2013 |pmid=24423677 |doi= |url=}}</ref><ref name="pmid27338496">{{cite journal |vauthors=Kamo M, Fuwa S, Fukuda K, Fujita Y, Kurihara Y |title=Provocative Endoscopy to Identify Bleeding Site in Upper Gastrointestinal Bleeding: A Novel Approach in Transarterial Embolization |journal=J Vasc Interv Radiol |volume=27 |issue=7 |pages=968–72 |year=2016 |pmid=27338496 |doi=10.1016/j.jvir.2016.03.009 |url=}}</ref><ref name="pmid19368506">{{cite journal |vauthors=Calvet X, Sánchez-Delgado J, Montserrat A, Lario S, Ramírez-Lázaro MJ, Quesada M, Casalots A, Suárez D, Campo R, Brullet E, Junquera F, Sanfeliu I, Segura F |title=Accuracy of diagnostic tests for Helicobacter pylori: a reappraisal |journal=Clin. Infect. Dis. |volume=48 |issue=10 |pages=1385–91 |year=2009 |pmid=19368506 |doi=10.1086/598198 |url=}}</ref><ref name="pmid8855734">{{cite journal |vauthors=Thijs JC, van Zwet AA, Thijs WJ, Oey HB, Karrenbeld A, Stellaard F, Luijt DS, Meyer BC, Kleibeuker JH |title=Diagnostic tests for Helicobacter pylori: a prospective evaluation of their accuracy, without selecting a single test as the gold standard |journal=Am. J. Gastroenterol. |volume=91 |issue=10 |pages=2125–9 |year=1996 |pmid=8855734 |doi= |url=}}</ref><ref name="pmid2072790">{{cite journal |vauthors=Mamel JJ |title=Use of endoscopy in peptic ulcer disease |journal=Med. Clin. North Am. |volume=75 |issue=4 |pages=841–51 |year=1991 |pmid=2072790 |doi= |url=}}</ref>


===Algorithm for the Approach to Dyspepsia===
===Algorithm for the Approach to Dyspepsia===
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==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
<references />


[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Primary care]]

Latest revision as of 23:37, 29 July 2020

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

Overview

Endoscopy is helpful in the diagnosis of peptic ulcer disease.Endoscopy with biopsy is recommended to diagnose cancer in patients 55 years or older, or with one or more alarm symptoms such as unexplained weight loss, progressive dysphagia, odynophagia, recurrent vomiting, family history of gastrointestinal cancer, overt gastrointestinal bleeding, abdominal mass, iron deficiency anemia.

Peptic ulcer esophagogastroduodenoscopy

According to American College of Gastroenterology (ACG) guidelines 2017 for the treatment of H pylori infection (HPI) include the following recommendations for testing for H pylori:[1]

Pre-endoscopic medical therapy

  • Intravenous infusion of erythromycin 250 mg,30 min before endoscopy improve diagnostic yield and decrease the need for repeat endoscopy
  • Intravenous PPI 80 mg bolus followed by 8 mg/h infusion decreases the number of patients who have higher risk of bleeding at endoscopy[2]

Timing of endoscopy

  • Patients with bleeding ulcer should undergo endoscopy within 24 h of admission, following resuscitative efforts to stabilize hemodynamically
  • Hemodynamically stable patients ,endoscopy should be performed early and discharged on the same day
  • Patients with unstable signs and symptoms e.g tachycardia, hypotension, bloody emesis or nasogastric aspirate in the hospital endoscopy should be done within 12 hours

Different endoscopic test:

Algorithm for the Approach to Dyspepsia


 
 
 
 
 
Age ≥ 55 or ⊕ alarm features*?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
YES
 
 
 
 
 
 
 
NO
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Endoscopy
 
 
 
 
 
 
 
H. pylori prevalence?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
High
 
 
 
 
 
 
 
Low
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Test-and-treat strategy ± acid suppression
 
 
 
 
 
 
 
Acid suppression trial
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
If eradication therapy is indicated
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Clarithromycin resistance ≥ 20%
 
 
 
 
 
 
 
Clarithromycin resistance < 20%
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Quadruple or sequential therapy
 
 
 
 
 
 
 
PCA or PCM or Bismuth quadruple therapy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
PLA
 
 
 
 
 
 
 
Bismuth quadruple therapy or PLA
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Adjust Rx per susceptibility test
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Consider endoscopy if treatment fails
 
 
 
 
 
 
 
 
 
 
  • Alarm symptoms-unexplained weight loss, progressive dysphagia, odynophagia, recurrent vomiting, family history of gastrointestinal cancer, overt gastrointestinal bleeding, abdominal mass, iron deficiency anemia, or jaundice[3]

References

  1. ↑ {{cite web |url=https://www.nature.com/ajg/journal/v112/n2/pdf/ajg2016563a.pdf |title=www.nature.com |format= |work= |accessdat
  2. ↑ "Management of Patients with Ulcer Bleeding | American College of Gastroenterology".
  3. ↑ 3.0 3.1 Bowrey DJ, Griffin SM, Wayman J, Karat D, Hayes N, Raimes SA (2006). "Use of alarm symptoms to select dyspeptics for endoscopy causes patients with curable esophagogastric cancer to be overlooked". Surg Endosc. 20 (11): 1725–8. doi:10.1007/s00464-005-0679-3. PMID 17024539.
  4. ↑ "Management of Patients with Ulcer Bleeding | American College of Gastroenterology".
  5. ↑ Girdalidze AM, Elisabedashvili GV, Sharvadze LG, Dzhorbenadze TA (2013). "[Comparative diagnostic value of Helicobacter pylori infection testing methods]". Georgian Med News (in Russian) (225): 53–60. PMID 24423677.
  6. ↑ Kamo M, Fuwa S, Fukuda K, Fujita Y, Kurihara Y (2016). "Provocative Endoscopy to Identify Bleeding Site in Upper Gastrointestinal Bleeding: A Novel Approach in Transarterial Embolization". J Vasc Interv Radiol. 27 (7): 968–72. doi:10.1016/j.jvir.2016.03.009. PMID 27338496.
  7. ↑ Calvet X, Sánchez-Delgado J, Montserrat A, Lario S, Ramírez-Lázaro MJ, Quesada M, Casalots A, Suárez D, Campo R, Brullet E, Junquera F, Sanfeliu I, Segura F (2009). "Accuracy of diagnostic tests for Helicobacter pylori: a reappraisal". Clin. Infect. Dis. 48 (10): 1385–91. doi:10.1086/598198. PMID 19368506.
  8. ↑ Thijs JC, van Zwet AA, Thijs WJ, Oey HB, Karrenbeld A, Stellaard F, Luijt DS, Meyer BC, Kleibeuker JH (1996). "Diagnostic tests for Helicobacter pylori: a prospective evaluation of their accuracy, without selecting a single test as the gold standard". Am. J. Gastroenterol. 91 (10): 2125–9. PMID 8855734.
  9. ↑ Mamel JJ (1991). "Use of endoscopy in peptic ulcer disease". Med. Clin. North Am. 75 (4): 841–51. PMID 2072790.
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