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General Medicine

Peptic Ulcer Disease

Fozia Akhtar Ali, MD, Paula A. Shelton, MD and Anh Dinh, MD Reviewed 06/2018
 


BASICS

DESCRIPTION

  • Duodenal ulcer

    • Most common form of peptic ulcer

    • Usually located in the proximal duodenum

    • Multiple ulcers or ulcers distal to the second portion of duodenum raise possibility of gastri...

DIAGNOSIS

HISTORY

  • Signs and symptoms:

    • Duodenal ulcer

      • Mid-epigastric pain

      • Gnawing or burning, nonradiating, recurring pain that is often is episodic and relieved by food or antacids.

    • Gastric ulcer

      • Mid-...

TREATMENT

MEDICATION

First Line

  • Acid suppression: PPIs. PPIs have higher efficacy than H2 blockers. 95% of duodenal ulcers heal on PPI therapy within 4 weeks.

ONGOING CARE

FOLLOW UP RECOMMENDATIONS

Patient Monitoring

  • H. pylori eradication: expected in >90% (with double antibiotic regimen): Confirm eradication with urea breath test.

  • Acute duodenal ulcer: Mon...

REFERENCES

1
Bertleff MJ, Lange JF. Perforated peptic ulcer disease: a review of history and treatment. Dig Surg.  2010;27(3):161–169. [View Abstract on OvidMedline]
2
Neumann I, Letelier LM, Rada ...

ADDITIONAL READING

Echizen H. The first-in-class potassium-competitive acid blocker, vonoprazan fumarate: pharmacokinetic and pharmacodynamics considerations. Clin Pharmacokinet.  2016;55(4):409–...

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

  • In patients with PUD, eradicate H. pylori to assist healing and reduce the risk of recurrence.

  • Upper endoscopy is indicated for patients with suspected peptic ulcers and red flag sympto...

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Related Images
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Figure 15-14 Perforated peptic ulcer of stomach.
Figure 15-14 Perforated peptic ulcer of stomach.
Gastric ulcer. The stomach has been opened to reveal a sharply demarcated, deep peptic ulcer on the lesser curvature.
Gastric ulcer. The stomach has been opened to reveal a sharply demarcated, deep peptic ulcer on the lesser curvature.
Duodenal ulcer. A sharply punched-out peptic ulcer of the duodenum is situated immediately below the pylorus.
Duodenal ulcer. A sharply punched-out peptic ulcer of the duodenum is situated immediately below the pylorus.
Fig GI 10-10 Peptic ulcer disease. (A) Large incisura (black arrow) simulating a filling defect on the greater curvature. The incisura is incited by a long ulcer (white arrows) on the lesser curvature. (B) Double pylorus. The true pylorus and the accessory channel along the lesser curvature are separated by a bridge, or septum, that produces the appearance of a discrete lucent filling defect (arrow).
Fig GI 10-10 Peptic ulcer disease. (A) Large incisura (black arrow) simulating a filling defect on the greater curvature. The incisura is i...
Fig GI 10-10 Peptic ulcer disease. (A) Large incisura (black arrow) simulating a filling defect on the greater curvature. The incisura is incited by a long ulcer (white arrows) on the lesser curvature. (B) Double pylorus. The true pylorus and the accessory channel along the lesser curvature are separated by a bridge, or septum, that produces the appearance of a discrete lucent filling defect (arrow).
Fig GI 10-10 Peptic ulcer disease. (A) Large incisura (black arrow) simulating a filling defect on the greater curvature. The incisura is i...
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