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{{CMG}}; {{AE}} :{{MKK}}
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==Overview==
==Overview==
The hallmark of peptic ulcer disease is an episodic [[epigastric pain]] which cause awakening at night.A positive history of epigastric pain, use of drugs like [[NSAIDs|NSAID]]<nowiki/>s including aspirin  which inhibit cyclooxygenase,use of antiplatelets ,steroids and family history of peptic ulcer disease is suggestive of peptic ulcer disease. The most common symptoms of peptic ulcer disease include episodic [[epigastric pain]], [[heartburn]], loss of appettite, [[gastroesophageal reflux]], waterbrash,hematemesis and melena. Less common symptoms of peptic ulcer disease include  bloating,intolerance to fatty food<ref name="pmid17956071">{{cite journal| author=Ramakrishnan K, Salinas RC| title=Peptic ulcer disease. | journal=Am Fam Physician | year= 2007 | volume= 76 | issue= 7 | pages= 1005-12 | pmid=17956071 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17956071  }} </ref><ref name="pmid28798512">{{cite journal| author=Drini M| title=Peptic ulcer disease and non-steroidal anti-inflammatory drugs. | journal=Aust Prescr | year= 2017 | volume= 40 | issue= 3 | pages= 91-93 | pmid=28798512 | doi=10.18773/austprescr.2017.037 | pmc=5478398 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28798512  }} </ref>
The hallmark of [[peptic ulcer disease]] is an episodic [[epigastric pain]] which cause awakening at night.A positive history of [[epigastric pain]], use of drugs like [[NSAIDs|NSAID]]<nowiki/>s including [[aspirin]] which inhibit [[cyclooxygenase]],use of antiplatelets ,[[steroids]] and [[family history]] of [[peptic ulcer disease]] is suggestive of [[peptic ulcer disease]]. The most common symptoms of peptic ulcer disease include episodic [[epigastric pain]], [[heartburn]], loss of appettite, [[gastroesophageal reflux]], waterbrash,[[hematemesis]] and [[melena]]. Less common symptoms of [[peptic ulcer disease]] include  [[bloating]],intolerance to fatty food<ref name="pmid17956071">{{cite journal| author=Ramakrishnan K, Salinas RC| title=Peptic ulcer disease. | journal=Am Fam Physician | year= 2007 | volume= 76 | issue= 7 | pages= 1005-12 | pmid=17956071 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17956071  }} </ref><ref name="pmid28798512">{{cite journal| author=Drini M| title=Peptic ulcer disease and non-steroidal anti-inflammatory drugs. | journal=Aust Prescr | year= 2017 | volume= 40 | issue= 3 | pages= 91-93 | pmid=28798512 | doi=10.18773/austprescr.2017.037 | pmc=5478398 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28798512  }} </ref>


==History ==
==History ==
Obtaining the history is the most important aspect of making a [[diagnosis]] of  peptic ulcer disease. It provides insight into the [[Causality|cause]], precipitating factors and associated [[comorbid]] conditions.
Obtaining the history is the most important aspect of making a [[diagnosis]] of  [[peptic ulcer disease]]. It provides insight into the [[Causality|cause]], precipitating factors and associated [[comorbid]] conditions.


===Past Medical History===
===Past Medical History===
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===Medication History===
===Medication History===
*Prior use of [[aspirin]] or [[Non-steroidal anti-inflammatory drug|nonsteroidal anti-inflammatory drugs]] (NSAIDs) is important because these patients have an increased risk of [[gastric ulcer]] and a fourfold risk of significant [[Gastrointestinal tract|GI]] [[bleeding]] compared with other patients.<ref name="pmid5303551">{{cite journal |vauthors=Goulston K, Cooke AR |title=Alcohol, aspirin, and gastrointestinal bleeding |journal=Br Med J |volume=4 |issue=5632 |pages=664–5 |year=1968 |pmid=5303551 |pmc=1912769 |doi= |url=}}</ref>
*Prior use of [[aspirin]] or [[Non-steroidal anti-inflammatory drug|nonsteroidal anti-inflammatory drugs]] (NSAIDs) is important because these patients have an increased risk of [[gastric ulcer]] and a fourfold risk of significant [[Gastrointestinal tract|GI]] [[bleeding]] compared with other patients<ref name="pmid5303551">{{cite journal |vauthors=Goulston K, Cooke AR |title=Alcohol, aspirin, and gastrointestinal bleeding |journal=Br Med J |volume=4 |issue=5632 |pages=664–5 |year=1968 |pmid=5303551 |pmc=1912769 |doi= |url=}}</ref>
===Social History===
===Social History===
*Helicobacter pylori infection is more common in lw socioeconomic status and increased number of siblings.<ref name="pmid18783514">{{cite journal |vauthors=Bruce MG, Maaroos HI |title=Epidemiology of Helicobacter pylori infection |journal=Helicobacter |volume=13 Suppl 1 |issue= |pages=1–6 |year=2008 |pmid=18783514 |doi=10.1111/j.1523-5378.2008.00631.x |url=}}</ref>
*[[Helicobacter pylori infection]] is more common in [[low socioeconomic status]] and increased number of siblings<ref name="pmid18783514">{{cite journal |vauthors=Bruce MG, Maaroos HI |title=Epidemiology of Helicobacter pylori infection |journal=Helicobacter |volume=13 Suppl 1 |issue= |pages=1–6 |year=2008 |pmid=18783514 |doi=10.1111/j.1523-5378.2008.00631.x |url=}}</ref>
*Alcoholics also frequently have [[peptic ulcers]] or [[gastritis]].<ref name="pmid2226291">{{cite journal |vauthors=MacMath TL |title=Alcohol and gastrointestinal bleeding |journal=Emerg. Med. Clin. North Am. |volume=8 |issue=4 |pages=859–72 |year=1990 |pmid=2226291 |doi= |url=}}</ref><ref name="pmid5303551" />
*[[Alcoholics]] also frequently have [[peptic ulcers]] or [[gastritis]]<ref name="pmid2226291">{{cite journal |vauthors=MacMath TL |title=Alcohol and gastrointestinal bleeding |journal=Emerg. Med. Clin. North Am. |volume=8 |issue=4 |pages=859–72 |year=1990 |pmid=2226291 |doi= |url=}}</ref><ref name="pmid5303551" />
*[[Cigarette smoke|Cigarette smokers]] have a significantly higher rate of the recurrent [[duodenal ulcer]] as compared with nonsmokers and a history of [[cigarette smoking]] should be elicited<ref name="pmid28839832">{{cite journal |vauthors=Jafar W, Jafar AJN, Sharma A |title=Upper gastrointestinal haemorrhage: an update |journal=Frontline Gastroenterol |volume=7 |issue=1 |pages=32–40 |year=2016 |pmid=28839832 |pmc=5369541 |doi=10.1136/flgastro-2014-100492 |url=}}</ref><ref name="pmid17942452">{{cite journal |vauthors=Palmer K |title=Acute upper gastrointestinal haemorrhage |journal=Br. Med. Bull. |volume=83 |issue= |pages=307–24 |year=2007 |pmid=17942452 |doi=10.1093/bmb/ldm023 |url=}}</ref>
*[[Cigarette smoke|Cigarette smokers]] have a significantly higher rate of the recurrent [[duodenal ulcer]] as compared with nonsmokers <ref name="pmid28839832">{{cite journal |vauthors=Jafar W, Jafar AJN, Sharma A |title=Upper gastrointestinal haemorrhage: an update |journal=Frontline Gastroenterol |volume=7 |issue=1 |pages=32–40 |year=2016 |pmid=28839832 |pmc=5369541 |doi=10.1136/flgastro-2014-100492 |url=}}</ref><ref name="pmid17942452">{{cite journal |vauthors=Palmer K |title=Acute upper gastrointestinal haemorrhage |journal=Br. Med. Bull. |volume=83 |issue= |pages=307–24 |year=2007 |pmid=17942452 |doi=10.1093/bmb/ldm023 |url=}}</ref>


===Family History===
===Family History===
*Family history of peptic ulcer disease increases the risk of peptic ulcer.
*Family history of [[peptic ulcer disease]] increases the risk of [[peptic ulcer]]
*History of peptic ulcer disease in mother increases the risk of peptic ulcer disease in children.
*History of [[peptic ulcer disease]] in mother increases the risk of [[peptic ulcer disease]] in [[children]]


== Symptoms ==
== Symptoms ==
*The majority of patients with the peptic ulcer disease are symptomatic but some people donot show any symptoms,called as a silent ulcer.
*The majority of patients with the [[peptic ulcer disease]] are symptomatic but some people donot show any symptoms,called as a silent ulcer.
*The hallmark of peptic ulcer disease :
*The hallmark of [[peptic ulcer disease]]:
**Episodic gnawing or burning epigastric pain which occurs two to five hours after meals or on an empty stomach
**Episodic gnawing or burning [[epigastric pain]] which occurs one to five hours after meals or on an empty [[stomach]]
**Nocturnal pain relieved by food intake, [[Antacid|antacids]], or [[antisecretory agents]].<ref name="pmid17956071" />
**Nocturnal [[pain]] relieved by [[food]] intake, [[Antacid|antacids]], or antisecretory agents<ref name="pmid17956071" />
**Chronic use of [[NSAIDs]].
**Chronic use of [[NSAIDs]]
{| class="wikitable"
{| class="wikitable"
! colspan="3" |Difference in symptoms of gastric and duodenal ulcer
! colspan="3" |Difference in symptoms of gastric and duodenal ulcer
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|'''Duodenal ulcer'''  
|'''Duodenal ulcer'''  
|-
|-
| rowspan="3" |Epigastric pain
| rowspan="3" |[[Epigastric pain]]
|Occurs 1-2 hours after eating  
|Occurs 1-2 hours after eating  
|Occurs 2-5 hours after eating
|Occurs 2-5 hours after eating
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|Decreases with eating  
|Decreases with eating  
|-
|-
|Pain at night  is less common  
|[[Pain]] at night  is less common  
|Pain at night  is more common  
|[[Pain]] at night  is more common  
|-
|-
|Heartburn, chest discomfort  
|[[Heartburn]], [[chest discomfort]]
and early satiety  
and early [[satiety]]
|Occurs commonly  
|Occurs commonly  
|Less  commonly  occurs  
|Less  commonly  occurs  
|-
|-
|Bleeding presentation
|[[Bleeding]] presentation
|
|
* Melena  
* [[Melena]]


* Hematemesis  
* [[Hematemesis]]
|
|
* Melena  
* [[Melena]]
* Hematochezia  
* [[Hematochezia]]
|}
|}


===Common Symptoms===
===Common Symptoms===
Common symptoms of peptic ulcer disease include:
Common symptoms of [[peptic ulcer disease]] include:
*Episodic [[epigastric pain]]  
*Episodic [[epigastric pain]]  
*[[Heartburn]]  
*[[Heartburn]]  
*[[ Waterbrash]]
*Waterbrash  
*[[Indigestion]]  
*[[Indigestion]]  
*[[Hematemesis]]
*[[Hematemesis]]
*[[Melena]]
*[[Melena]]
*[[Loss ofappetite|Loss of appetite]]
*Loss of appetite


===Less Common Symptoms===
===Less Common Symptoms===

Revision as of 23:23, 27 November 2017

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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

The hallmark of peptic ulcer disease is an episodic epigastric pain which cause awakening at night.A positive history of epigastric pain, use of drugs like NSAIDs including aspirin which inhibit cyclooxygenase,use of antiplatelets ,steroids and family history of peptic ulcer disease is suggestive of peptic ulcer disease. The most common symptoms of peptic ulcer disease include episodic epigastric pain, heartburn, loss of appettite, gastroesophageal reflux, waterbrash,hematemesis and melena. Less common symptoms of peptic ulcer disease include bloating,intolerance to fatty food[1][2]

History

Obtaining the history is the most important aspect of making a diagnosis of peptic ulcer disease. It provides insight into the cause, precipitating factors and associated comorbid conditions.

Past Medical History

Medication History

Social History

Family History

Symptoms

Difference in symptoms of gastric and duodenal ulcer
Gastric ulcer Duodenal ulcer
Epigastric pain Occurs 1-2 hours after eating Occurs 2-5 hours after eating
Increases with eating Decreases with eating
Pain at night is less common Pain at night is more common
Heartburn, chest discomfort

and early satiety

Occurs commonly Less commonly occurs
Bleeding presentation

Common Symptoms

Common symptoms of peptic ulcer disease include:

Less Common Symptoms

Less common symptoms of peptic ulcer disease include:

References

  1. ↑ 1.0 1.1 Ramakrishnan K, Salinas RC (2007). "Peptic ulcer disease". Am Fam Physician. 76 (7): 1005–12. PMID 17956071.
  2. ↑ Drini M (2017). "Peptic ulcer disease and non-steroidal anti-inflammatory drugs". Aust Prescr. 40 (3): 91–93. doi:10.18773/austprescr.2017.037. PMC 5478398. PMID 28798512.
  3. ↑ Laine, Loren; Solomon, Caren G. (2016). "Upper Gastrointestinal Bleeding Due to a Peptic Ulcer". New England Journal of Medicine. 374 (24): 2367–2376. doi:10.1056/NEJMcp1514257. ISSN 0028-4793.
  4. ↑ 4.0 4.1 Goulston K, Cooke AR (1968). "Alcohol, aspirin, and gastrointestinal bleeding". Br Med J. 4 (5632): 664–5. PMC 1912769. PMID 5303551.
  5. ↑ Bruce MG, Maaroos HI (2008). "Epidemiology of Helicobacter pylori infection". Helicobacter. 13 Suppl 1: 1–6. doi:10.1111/j.1523-5378.2008.00631.x. PMID 18783514.
  6. ↑ MacMath TL (1990). "Alcohol and gastrointestinal bleeding". Emerg. Med. Clin. North Am. 8 (4): 859–72. PMID 2226291.
  7. ↑ Jafar W, Jafar A, Sharma A (2016). "Upper gastrointestinal haemorrhage: an update". Frontline Gastroenterol. 7 (1): 32–40. doi:10.1136/flgastro-2014-100492. PMC 5369541. PMID 28839832. Vancouver style error: initials (help)
  8. ↑ Palmer K (2007). "Acute upper gastrointestinal haemorrhage". Br. Med. Bull. 83: 307–24. doi:10.1093/bmb/ldm023. PMID 17942452.


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