Peptic ulcer differential diagnosis
Overview
The main symptom of uncomplicated peptic ulcer disease (PUD) is epigastric pain, which usually can be accompanied by other symptoms such as bloating, fullness, early satiety and nausea, but can be also asymptomatic, specially NSAID-related ulcer, for which upper gastrointestinal bleeding or perforation might be the first manifestation of the disease.[1] So, in order to differentiate PUD we must consider other diseases which can present with pain, upper gastrointestinal bleeding or acute abdomen
Differentiating Peptic Ulcer from other Diseases
- Acute upper gastrointestinal bleeding: PUD accounts for the majority of acute episodes of gastrointestinal bleeding[2] (up to 40%)[3], but there are other causes:[4]
- Esophageal varices: history of cirrhosis (and portal hypertension)
- Mallory-Weiss syndrome: history of repeated vomiting
- Gastrointestinal cancer: history of anorexia or weight loss, tobacco smoking and alcohol drinking.
- Arteriovenous malformations: Painless bleeding in >70 years old patients, history of iron deficiency anemia.
- Esophagitis or esophageal ulcer: heartburn, indigestion, or dysphagia
- Dieulafoy ulcer: painless bleeding
- Alpha-1 Antitrypsin Deficiency AATD: besides lung disease, liver disease (hepatitis, cirrhosis, and hepatoma) represents another clinical manifestation of AATD,[5][6] therefore those patients can present upper gastrointestinal bleeding and abdominal pain, in the context of altered liver function.[7]
- Cirrhosis
- Gastroesophageal reflux disease (GERD)
- Hyperparathyroidism
- Irritable bowel syndrome
- Pancreatitis
- Zollinger-Ellison Syndrome
References
- ↑ Malfertheiner P, Chan FK, McColl KE (2009). "Peptic ulcer disease". Lancet. 374 (9699): 1449–61. doi:10.1016/S0140-6736(09)60938-7. PMID 19683340.
- ↑ Gralnek IM, Barkun AN, Bardou M (2008). "Management of acute bleeding from a peptic ulcer". N Engl J Med. 359 (9): 928–37. doi:10.1056/NEJMra0706113. PMID 18753649.
- ↑ Dallal HJ, Palmer KR (2001). "ABC of the upper gastrointestinal tract: Upper gastrointestinal haemorrhage". BMJ. 323 (7321): 1115–7. PMC 1121602. PMID 11701581.
- ↑ Wilkins T, Khan N, Nabh A, Schade RR (2012). "Diagnosis and management of upper gastrointestinal bleeding". Am Fam Physician. 85 (5): 469–76. PMID 22534226.
- ↑ Stoller JK, Aboussouan LS (2012). "A review of α1-antitrypsin deficiency". Am J Respir Crit Care Med. 185 (3): 246–59. doi:10.1164/rccm.201108-1428CI. PMID [ 21960536 [ Check
|pmid=value (help). - ↑ Silverman EK, Sandhaus RA (2009). "Clinical practice. Alpha1-antitrypsin deficiency". N Engl J Med. 360 (26): 2749–57. doi:10.1056/NEJMcp0900449. PMID 19553648.
- ↑ Nelson DR, Teckman J, Di Bisceglie AM, Brenner DA (2012). "Diagnosis and management of patients with α1-antitrypsin (A1AT) deficiency". Clin Gastroenterol Hepatol. 10 (6): 575–80. doi:10.1016/j.cgh.2011.12.028. PMC 3360829. PMID 22200689.