Gastroenterology Book

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Peptic Ulcer Disease

Aka: Peptic Ulcer Disease, PUD, Gastric Ulcer, Duodenal Ulcer
  1. See Also
    1. Dyspepsia
  2. Epidemiology
    1. Incidence: 500,000 cases per year in U.S.
  3. Etiologies
    1. Nonsteroidal Antiinflammatory Drugs (NSAIDs)
      1. Peptic ulcers occur in 5-20% of longterm NSAID use
    2. Helicobacter Pylori
      1. Duodenal Ulcer: 90-100% Prevalence
      2. Gastric Ulcer: 70-90% Prevalence
    3. Acid Induced Ulcers
      1. Idiopathic
      2. Zollinger-Ellison Syndrome
    4. Chronic Disease
      1. Stress Ulcers in chronic debilitated conditions
      2. Chronic Obstructive Pulmonary Disease
      3. Cystic Fibrosis
      4. Alpha-1-Antitrypsin Deficiency
      5. Systemic Mastocytosis
      6. Basophilic Leukemia
      7. Chronic Renal Failure
      8. Cirrhosis
  4. Risk Factors
    1. See Gastric Irritants
  5. Symptoms
    1. Duodenal Ulcer
      1. Mid-Epigastric Pain, deep recurring ache
      2. Relieved with food or antacids
      3. Aggravated by general irritants (below)
      4. Nocturnal pain is present
    2. Gastric Ulcer
      1. Mid-Epigastric Pain
      2. Relieved by antacids
      3. Aggravated by food and general irritants (below)
      4. Constitutional symptoms
        1. Anorexia
        2. Weight loss
        3. Nausea or Vomiting
  6. Red Flags
    1. See Dyspepsia Red Flags
  7. Presentations: Special cohorts
    1. Children (rare): Presents with poorly localized Abdominal Pain
    2. Elderly
      1. Presents asymptomatically or non-specifically (e.g. confusion, abdominal distention)
      2. High risk of perforation and mortality
    3. Stress Ulcers
      1. Presents in seriously ill hospitalized patients (Mechanical Ventilation, Burn Injury)
    4. Pregnancy
      1. See Dyspepsia in Pregnancy
  8. Differential Diagnosis
    1. See Dyspepsia Causes
    2. See Medication Causes of Dyspepsia
    3. Cholecystitis
    4. Pancreatitis
    5. Appendicitis
    6. Gastric Cancer
    7. Ischemic bowel disease in the elderly
    8. Inflammatory Bowel Disease
  9. Diagnostics
    1. See Dyspepsia for evaluation protocol
    2. No additional investigation necessary if
      1. Symptoms consistent with Duodenal Ulcer and
      2. Medication leads to healing within 6 weeks
    3. Upper Endoscopy Indications
      1. Assess and reassess Gastric Ulcers
      2. Evaluate for Gastric Carcinoma in high risk groups
        1. See Dyspepsia Red Flags
    4. Upper GI with Follow Through
      1. May be sufficient for Duodenal Ulcers
    5. Helicobacter Pylori testing if ulcer not NSAID related
      1. See Helicobacter pylori Noninvasive Testing
  10. Management: General Measures
    1. Avoid Gastric Irritants
    2. Avoid bland diets (not effective)
      1. May stimulate greater acid production
  11. Management: Cause specific
    1. NSAID associated peptic ulcer
      1. H2 Antagonist or Proton Pump Inhibitor
      2. Consider Misoprostol
    2. Non-NSAID Associated Peptic Ulcer disease
      1. Helicobacter Pylori Treatment
      2. H2 Antagonist or Proton Pump Inhibitor
  12. Management: Refractory Peptic Ulcer
    1. Causes
      1. Persistent NSAID use
      2. Resistant Helicobacter Pylori infection
      3. Gastric Cancer
      4. Zollinger-Ellison Syndrome
    2. Measures
      1. Continue Proton Pump Inhibitors
      2. Consider surgical intervention in severe cases or those at high risk of complications
        1. Duodenal Ulcer: Vagotomy or Partial Gastrectomy
        2. Gastric Ulcer: Partial Gastrectomy
  13. Prognosis
    1. Proton Pump Inhibitors have higher efficacy than H2 Antagonists
    2. On Proton Pump Inhibitor
      1. Duodenal Ulcers heal in 95% of cases within 4 week
      2. Gastric Ulcers heal in 80-90% of cases within 8 weeks
    3. Recurrence risk (Duodenal Ulcers)
      1. Non-smoker recurrence in 1 year: 60%
      2. Smoker recurrence in 1 year: >75%
  14. Complications: 25% of cases (especially in Elderly taking NSAIDs)
    1. Gastrointestinal Hemorrhage (15-20% of cases)
      1. See Upper Gastrointestinal Bleeding
    2. Gastrointestinal Perforation
    3. Gastric Outlet Obstruction
  15. References
    1. Soll in Goldman (2000) Cecil Medicine, p. 671-84
    2. Behrman (2005) Arch Surg 140:201-8
    3. Ramakrishnan (2007) Am Fam Physician 76(7):1005-12
    4. Smoot (2001) Prim Care 28(3):487-503

Peptic Ulcer (C0030920)

Definition (MEDLINEPLUS)

A peptic ulcer is a sore in the lining of your stomach or your duodenum, the first part of your small intestine. A burning stomach pain is the most common symptom. The pain

  • May come and go for a few days or weeks
  • May bother you more when your stomach is empty
  • Usually goes away after you eat

Peptic ulcers happen when the acids that help you digest food damage the walls of the stomach or duodenum. The most common cause is infection with a bacterium called Helicobacter pylori. Another cause is the long-term use of nonsteroidal anti-inflammatory medicines (NSAIDs) such as aspirin and ibuprofen. Stress and spicy foods do not cause ulcers, but can make them worse.

Peptic ulcers will get worse if not treated. Treatment may include medicines to block stomach acids or antibiotics to kill ulcer-causing bacteria. Not smoking and avoiding alcohol can help. Surgery may help for ulcers that don't heal.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases
Definition (NCI) A break in the lining of the lower part of the esophagus, the stomach, or the upper part of the small intestine. Peptic ulcers form when cells on the surface of the lining become inflamed and die. They are usually caused by Helicobacter pylori bacteria and by certain medicines, such as aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs). Peptic ulcers may be linked to cancer and other diseases.
Definition (MSH) Ulcer that occurs in the regions of the GASTROINTESTINAL TRACT which come into contact with GASTRIC JUICE containing PEPSIN and GASTRIC ACID. It occurs when there are defects in the MUCOSA barrier. The common forms of peptic ulcers are associated with HELICOBACTER PYLORI and the consumption of nonsteroidal anti-inflammatory drugs (NSAIDS).
Definition (CSP) local defect produced by the sloughing of inflammatory necrotic tissue that occurs in the regions of the gastrointestinal tract which come into contact with gastric juice; occurs when there are defects in the mucosa barrier; common forms of peptic ulcers are associated with Helicobacter pylori and the consumption of nonsteroidal antiinflammatory drugs.
Concepts Disease or Syndrome (T047)
MSH D010437
ICD9 533
ICD10 K27
SnomedCT 155710009, 196704007, 196705008, 266437002, 196697002, 13200003, 155701001, 266501005, 196681007
English Ulcer disease, Ulcer, peptic, Gastroduodenal Ulcer, Gastroduodenal Ulcers, Peptic Ulcer, Ulcer, Gastroduodenal, Ulcers, Gastroduodenal, Ulcers, Peptic, PEPTIC ULCER SYNDROME, PEPTIC ULCER, PEPTIC ULCER DISEASE, SYNDROME PEPTIC ULCER, ULCER PEPTIC, ULCER SYNDROME PEPTIC, Ulcer, Peptic, Gastroduodenal ulcer, NOS, Peptic ulcer, NOS, ULCER GASTRODUODENAL, Peptic ulcer, site unspecified, Peptic ulcer - (PU) site unsp., Peptic ulcer - (PU) site unspecified, Peptic ulcer NOS, Unspecified peptic ulcer, Unspecified peptic ulcer NOS, gastroduodenal ulcer, peptic ulcer disease, pud, peptic ulcer (diagnosis), peptic ulcer, Peptic ulcer NOS (disorder), Ulcer gastroduodenal, GDU, Peptic ulcer syndrome, Syndrome peptic ulcer, Ulcer syndrome peptic, Ulcer peptic, PUD, Unspecified peptic ulcer NOS (disorder), Peptic ulcer - (PU) site unspecified (disorder), Unspecified peptic ulcer (disorder), gastroduodenal ulcer NOS, peptic ulcer NOS, Peptic Ulcer [Disease/Finding], peptic ulcer disorder, peptic ulcer nos, Ulcer;peptic, ulcer of the gastrointestinal tract, peptic ulcers, Peptic ulcer disease, Peptic ulcer, PU - Peptic ulcer, PUD - Peptic ulcer disease, Peptic ulceration, Gastroduodenal ulcer, Peptic ulcer (disorder), peptic; ulcer, ulcer; peptic, Peptic ulcer NOS = PU, Peptic Ulcers, Peptic Ulcer Disease, Peptic ulcer; site unspecified
French ULCERE PEPTIQUE, Syndrome d'ulcère peptique, Maladie ulcéreuse gastrique, Ulcère peptique, site non précisé, Ulcération peptique, MUP, Ulcère gastroduodénal, Ulcère peptique, Ulcère gastro-duodénal, Ulcères gastro-duodénaux, Ulcères gastroduodénaux
Portuguese ULCERA PEPTICA, Doença de úlcera péptica, Úlcera péptica, localização NE, Síndrome de úlcera péptica, Ulceração péptica, Úlcera gastroduodenal, Úlcera péptica, Úlcera Gastroduodenal, Úlcera Péptica
Spanish ULCERA PEPTICA, Síndrome ulceroso péptico, Síndrome de úlcera péptica, Úlcera péptica de localización no especificada, UGD, Enfermedad ulcerosa péptica, Ulceración péptica, EUP, Peptic ulcer, Peptic ulcer NOS = PU, Peptic ulcer NOS, Peptic ulcer - (PU) site unspecified, enfermedad pélvica ulcerosa, úlcera gastroduodenal, úlcera péptica (trastorno), úlcera péptica - localización no especificada (trastorno), úlcera péptica - localización no especificada, úlcera péptica no especificada (trastorno), úlcera péptica no especificada, SAI (trastorno), úlcera péptica no especificada, SAI, úlcera péptica no especificada, úlcera péptica, SAI (trastorno), úlcera péptica, SAI, úlcera péptica, Úlcera gastroduodenal, Úlcera péptica, Úlcera Gastroduodenal, Úlcera Péptica, Ulcera Gastroduodenal, Ulcera Peptica
Dutch peptisch ulcus plaats niet gespecificeerd, peptisch ulcus ziekte, peptisch ulcus syndroom, ulcus pepticum, ulcus pepticum syndroom, peptische ulceratie, ulcus gastroduodenaal, peptisch; ulcus, ulcus; peptisch, gastroduodenale ulcus, peptisch ulcus, Ulcus pepticum, lokalisatie niet gespecificeerd, Gastroduodenaal ulcus, Ulcus pepticum
German GDU, peptisches Ulkus, Stelle unspezifisch, Syndrom peptisches Ulkus, Ulkus peptisch, peptisches Ulkussyndrom, PUD, Ulkussyndrom peptisch, peptische Ulkuskrankheit, peptische Ulzeration, Ulkus, gastroduodenal, ULKUS PEPTICUM, Ulcus pepticum, Lokalisation nicht naeher bezeichnet, Gastroduodenalulkus, peptisches Ulkus, Ulcus gastroduodenale, Ulcus pepticum
Italian Ulcerazione peptica, Malattia ulcerosa peptica, Sindrome da ulcera peptica, Ulcera peptica, sito non specificato, Ulcera gastro-duodenale, Ulcera gastroduodenale, Ulcera peptica
Japanese 消化性潰瘍疾患, 部位不明の消化性潰瘍, 消化性潰瘍症候群, ｲｼﾞｭｳﾆｼﾁｮｳｶｲﾖｳ, ｼｮｳｶｾｲｶｲﾖｳｼｯｶﾝ, ｼｮｳｶｾｲｶｲﾖｳ, ｼｮｳｶｾｲｶｲﾖｳｼｮｳｺｳｸﾞﾝ, ﾌﾞｲﾌﾒｲﾉｼｮｳｶｾｲｶｲﾖｳ, ストレス潰瘍, 辺縁性潰瘍, 辺縁潰瘍, 吻合口潰瘍, 吻合部潰瘍, 胃･十二指腸潰瘍, 術後空腸潰瘍, 吻合口縁辺潰瘍, 消化性潰瘍, 胃十二指腸潰瘍
Swedish Peptiskt sår
Czech peptický vřed, Gastroduodenální vřed, Peptický vřed, Vředová choroba, Syndrom peptického vředu, Peptický vřed blíže neurčené lokalizace
Finnish Peptinen haava
Russian KRAEVAIA IAZVA, GASTRODUODENAL'NAIA IAZVA, PEPTICHESKAIA IAZVA, ГАСТРОДУОДЕНАЛЬНАЯ ЯЗВА, КРАЕВАЯ ЯЗВА, ПЕПТИЧЕСКАЯ ЯЗВА
Korean 상세불명 부위의 소화성 궤양
Croatian PEPTIČKI ULKUS
Polish Wrzód brzeżny, Wrzód trawienny, Choroba wrzodowa
Hungarian PUD, Gyomor-patkóbél fekély, Peptikus fekély, Peptikus ulceratio, Gastroduodenalis fekély, Peptikus fekély szindróma, GDU, Peptikus fekélybetegség, Peptikus fekély, hely meghatározása nélkül, Peptikus fekély syndroma
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Duodenal Ulcer (C0013295)

Definition (NCI) An ulcer in the duodenal wall.
Definition (NCI) A disorder characterized by a circumscribed, inflammatory and necrotic erosive lesion on the mucosal surface of the duodenal wall.
Definition (MSH) A PEPTIC ULCER located in the DUODENUM.
Definition (CSP) peptic ulcer located in the duodenum, the shortest and widest portion of the small intestine adjacent to the pylorus of the stomach.
Concepts Disease or Syndrome (T047)
MSH D004381
ICD9 532
ICD10 K26
SnomedCT 553009, 155700000, 155691003, 196669008, 235703009, 196679005, 196672001, 196680008, 51868009, 367474008, 196651004
English Duodenal Ulcers, Ulcers, Duodenal, DUODENUM, ULCER, DUODENAL ULCER, DUODENAL ULCERATION, DUODENUM, PEPTIC ULCER, ULCER DUODENAL, Ulcer, Duodenal, Common duodenal ulcer, NOS, DUODENAL ULCER DISEASE, Duodenal ulcer disease, NOS, Duodenal ulcer, NOS, Peptic ulcer of duodenum, NOS, Duodenal ulcer NOS, Peptic ulcer of duodenum, Unspecified duodenal ulcer, Unspecified duodenal ulcer NOS, Duodenal Ulcer, du, Duodenal ulcer NOS (disorder), Peptic ulcer of duodenum (disorder), duodenal ulcer, duodenal ulcer (diagnosis), Ulcer duodenal, Unspecified duodenal ulcer NOS (disorder), Unspecified duodenal ulcer (disorder), duodenum ulcer (peptic), Duodenal Ulcer [Disease/Finding], duodenal ulceration, duodenum ulcer, Ulcer;duodenal, duodenum ulcers, duodenal ulcers, DU, Duodenal ulcer (diagnosis), Duodenal ulcer, DU - Duodenal ulcer, DUD - Duodenal ulcer disease, Duodenal ulcer disease, Common duodenal ulcer (disorder), Common duodenal ulcer, Duodenal ulcer disease (disorder), duodenum; ulcer, ulcer; duodenum, Common duodenal ulcer (disorder) [Ambiguous], Duodenal ulcer (disorder)
French ULCERE DUODENAL, Ulcere duodenal, UD, Ulcere duodenal (diagnostic), Ulcere duodenale, Ulcère duodénal, Ulcère du duodénum, Ulcères duodénaux
Portuguese ULCERA DUODENAL, Ulcera duodenal, Úlcera duodenal, Úlcera Duodenal
Spanish ULCERA DUODENAL, Úlcera duodenal, Duodenal ulcer disease, Peptic ulcer of duodenum, Duodenal ulcer, Ulcera duodenal, Duodenal ulcer NOS, UD, DU - úlcera Duodenal, enfermedad ulcerosa del duodeno (trastorno), enfermedad ulcerosa del duodeno, úlcera de duodeno (trastorno), úlcera de duodeno, úlcera duodenal (concepto no activo), úlcera duodenal (trastorno), úlcera duodenal común (trastorno), úlcera duodenal común, úlcera duodenal no especificada (trastorno), úlcera duodenal no especificada, SAI (trastorno), úlcera duodenal no especificada, SAI, úlcera duodenal no especificada, úlcera duodenal, SAI (trastorno), úlcera duodenal, SAI, úlcera duodenal, úlcera péptica del duodeno, Úlcera de duodeno, Úlcera Duodenal, Ulcera Duodenal
Swedish Tolvfingertarmssår, DUODENALSAR
Japanese ｼﾞｭｳﾆｼﾁｮｳｶｲﾖｳ, カーリング潰瘍, 十二指腸潰瘍, Curling潰瘍
Czech duodenum - vředy, Duodenální vřed
Finnish Pohjukaissuolihaava, POHJUKAISSUOLEN HAAVA
Russian DVENADTSATIPERSTNOI KISHKI IAZVA, KURLINGA IAZVA, ДВЕНАДЦАТИПЕРСТНОЙ КИШКИ ЯЗВА, КУРЛИНГА ЯЗВА
Norwegian SAR PA TOLVFINGERTARMEN
German ULKUS DUODENI, Ulcus duodeni, DU, Ulkus duodeni, Zwölffingerdarmgeschwür
Danish Ulcus duodeni
Hungarian ulcus duodeni, Duodenalis fekély, UD (ulcus duodeni), Duodenalis ulcus
Korean 십이지장궤양
Croatian DUODENALNI ULKUS
Basque DUODENO ULTZERA
Hebrew kiv hatrisarion
Polish Wrzód dwunastnicy, Wrzód Curlinga
Dutch DU, duodenum; ulcus, ulcus; duodenum, duodenumulcus, Ulcus duodeni, Duodenumulcus, Ulcus, duodenum-
Italian Ulcera duodenale (diagnosi), Ulcera duodenale
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Gastric ulcer (C0038358)

Definition (NCI) An ulcerated lesion in the mucosal surface of the stomach. It may progress to involve the deeper layers of the gastric wall.
Definition (NCI) A disorder characterized by a circumscribed, inflammatory and necrotic erosive lesion on the mucosal surface of the stomach.
Definition (MSH) Ulceration of the GASTRIC MUCOSA due to contact with GASTRIC JUICE. It is often associated with HELICOBACTER PYLORI infection or consumption of nonsteroidal anti-inflammatory drugs (NSAIDS).
Concepts Disease or Syndrome (T047)
MSH D013276
ICD9 531
ICD10 K25
SnomedCT 155681009, 155690002, 196642007, 196649003, 266436006, 397825006, 196627009, 6034002, 196650003
English Stomach Ulcer, Stomach Ulcers, Ulcers, Stomach, GASTRIC ULCER, GASTRIC ULCERATION, STOMACH ULCER, ULCER GASTRIC, ULCUS VENTRICULI, Ulcer, Stomach, GASTRIC ULCER DISEASE, Gastric ulcer, NOS, Stomach ulcer, NOS, ULCER STOMACH, Gastric ulcer NOS, Unspecified gastric ulcer, Unspecified gastric ulcer NOS, gastric ulcer (diagnosis), gastric ulcer, stomach ulcer, Gastric ulcer NOS (disorder), Ulcer gastric, GU, Ulcer stomach, Ulcus ventriculi, Unspecified gastric ulcer (disorder), Unspecified gastric ulcer NOS (disorder), Stomach Ulcer [Disease/Finding], Ulcer;gastric, Ulcer;stomach, gastric ulceration, gastric ulcer disease, gastric ulcers, ulcus ventriculi, gastric ulcerations, stomach ulcers, Gastric ulcer (diagnosis), GU - Gastric ulcer, Gastric ulceration, Stomach ulcer, Gastric ulcer (disorder), stomach; ulcer, ulcer; gastric, Gastric ulcer - (GU), Gastric Ulcer, Gastric Ulcers, Ulcers, Gastric, Ulcer, Gastric, Gastric ulcer
French ULCERE GASTRIQUE, Ulcère à l'estomac, UG, Ulcere gastrique, Ulcere gastrique (diagnostic), Ulcère gastrique, Ulcère de l'estomac
Portuguese ULCERA GASTRICA, Úlcera do estômago, ULCERADE ESTOMAGO, ULCUS VENTRICULI, Úlcera gástrica, Úlcera do Estômago, Úlcera Gástrica
Spanish ULCERA GASTRICA, Úlcera de estómago, Ulcus ventriculi, Gastric erosions, Gastric ulcer NOS, Gastric ulcer, Gastric ulcer - (GU), ULCERA DE ESTOMAGO, ULCUS VENTRICULI, UG, úlcera de estómago, úlcera gástrica (trastorno), úlcera gástrica no especificada (trastorno), úlcera gástrica no especificada, SAI (trastorno), úlcera gástrica no especificada, SAI, úlcera gástrica no especificada, úlcera gástrica, SAI (trastorno), úlcera gástrica, SAI, úlcera gástrica, Úlcera gástrica, Úlcera Gástrica, Úlcera del Estómago, Ulcera Gastrica, Ulcera del Estomago
German MAGENGESCHWUER, Geschwuer, Magen, MAGENULKUS, ULKUS VENTRICULI, GU, Magengeschwuer, Ulcus ventriculi, Magengeschwür
Dutch maagzweer, ulcus ventriculi, maag; ulcus, ulcus; maag, maagulcus, Maagulcus, Ulcus ventriculi, Ulcus, maag-, Maagzweer, Zweer, maag-
Swedish Magsår
Japanese ｲｶｲﾖｳ, 胃潰瘍, 胃かいよう
Czech žaludek - vředy, Žaludeční vřed
Finnish Mahahaava
Russian ZHELUDKA IAZVA, ЖЕЛУДКА ЯЗВА
Italian Ulcera gastrica, Ulcera gastrica (diagnosi), Ulcera dello stomaco
Korean 위궤양
Croatian ŽELUČANI ULKUS
Polish Choroba wrzodowa żołądka, Wrzód żołądka
Hungarian Gyomor fekélye, Gyomorfekély, GU
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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