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Peptic Ulcer Disease

Afsha Rais Kaisani, FAAFP, MD, Tasaduq Hussain Mir, FAAFP, MD and Bremmy L Alsbrooks, Doctor of Osteopathic Medicine, Master of Public Health, Bachelor of Biology Reviewed 04/2024
 


BASICS

Peptic ulcer disease (PUD) is characterized by defects in the stomach and/or duodenal mucosa, leading to inflammation and erosion of the underlying tissue by gastric acid and pepsin. 

DESCRIPTION

DIAGNOSIS

HISTORY

  • 70% of peptic ulcers are asymptomatic

  • Common symptoms: midepigastric pain; gnawing or burning, nonradiating, recurring pain that is often episodic

    • Duodenal ulcer: often have nocturnal p...

TREATMENT

MEDICATION

First Line

Acid suppression 
  • PPIs: higher efficacy; most duodenal ulcers heal within 4 weeks.

    • Oral: Omeprazole 20mg/day; lansoprazole 30mg/day; rabeprazole 20mg/day; esomeprazole 40mg...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

  • H. pylori eradication is expected in >90% (with double antibiotic regimen); confirm eradication 4 weeks after completing therapy with urea br...

REFERENCES

1
Lanas  A, Chan  FKL. Peptic ulcer disease. Lancet.  2017;390(10094):613–624. [View Abstract on OvidMedline]
2
Neumann ...

CODES

ICD10

  • K27.9 Peptic ulc, site unsp, unsp as ac or chr, w/o hemor or perf

  • K26.9 Duodenal ulcer, unspecified as acute or chronic, without hemorrhage or perforation

  • K25.9 Gastric ulcer, unspecified as ...

CLINICAL PEARLS

  • PPIs: higher efficacy than H₂-blockers for healing duodenal ulcers.

  • Eradicate H. pylori to assist healing and reduce the risk of recurrence.

  • EGD indications: patients with suspected pept...

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