Peptic ulcer differential diagnosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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:[8][9] chronic liver disease is often asymptomatic until complications occur, such as variceal bleeding, ascites, primary peritonitis, sepsis or hepatic encephalopathy.
- Gastroesophageal reflux disease (GERD):[10][11][12][13] current definition is "a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications.” Heartburn and regurgitation are the cardinal symptoms of GERD, but patients can often present dysphagia and chest pain. Less common symptoms include odynophagia, sialorrhea, subxiphoid pain or nausea. Also, patients can present extraesophageal GERD-related syndromes, such as chronic cough, laryngitis, asthma or erosion of dental enamel.
- 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.
- ↑ Tsochatzis EA, Bosch J, Burroughs AK (2014). "Liver cirrhosis". Lancet. 383 (9930): 1749–61. doi:10.1016/S0140-6736(14)60121-5. PMID 24480518.
- ↑ Schuppan D, Afdhal NH (2008). "Liver cirrhosis". Lancet. 371 (9615): 838–51. doi:10.1016/S0140-6736(08)60383-9. PMC 2271178. PMID 18328931.
- ↑ Kahrilas PJ (2008). "Clinical practice. Gastroesophageal reflux disease". N Engl J Med. 359 (16): 1700–7. doi:10.1056/NEJMcp0804684. PMC 3058591. PMID 18923172.
- ↑ Kahrilas PJ, Shaheen NJ, Vaezi MF, Hiltz SW, Black E, Modlin IM; et al. (2008). "American Gastroenterological Association Medical Position Statement on the management of gastroesophageal reflux disease". Gastroenterology. 135 (4): 1383–1391, 1391.e1–5. doi:10.1053/j.gastro.2008.08.045. PMID 18789939.
- ↑ Bredenoord AJ, Pandolfino JE, Smout AJ (2013). "Gastro-oesophageal reflux disease". Lancet. 381 (9881): 1933–42. doi:10.1016/S0140-6736(12)62171-0. PMID 23477993.
- ↑ Fox M, Forgacs I (2006). "Gastro-oesophageal reflux disease". BMJ. 332 (7533): 88–93. doi:10.1136/bmj.332.7533.88. PMC 1326932. PMID 16410582.