Materiały źródłowe

• #1 Gastric or peptic ulcer | Diagnosis and treatment | CUN

  https://www.cun.es/en/diseases-treatments/diseases/gastric-peptic-ulcer

  „Peptic ulcer appears due to an imbalance between aggressive forces (acid) and defensive forces (mucus barrier).” […] „The best test to diagnose an ulcer today is the upper endoscopy or gastroscopy.” […] „With gastroscopy, the location, size, shape and presence of other associated lesions can be known.” […] „In addition, it is possible to take biopsies through the gastroscope.” […] „The latter is very important, especially for gastric ulcers, since it allows us to know the nature of the ulcer and to say if it is benign or malignant.” […] „It also allows detecting the presence of Helicobacter pylori, a bacterium that promotes the appearance of ulcers in the stomach.”

• #1 Diagnosis of Peptic Ulcers (Stomach or Duodenal Ulcers) – NIDDK

  https://www.niddk.nih.gov/health-information/digestive-diseases/peptic-ulcers-stomach-ulcers/diagnosis

  Your doctor may ask you about your medical and family history, perform a physical exam, and order tests to diagnose a peptic ulcer, find its cause, and check for complications. […] To help diagnose a peptic ulcer, your doctor will take a medical and family history. […] A physical exam may help a doctor diagnose peptic ulcers or ulcer complications. […] Doctors may order medical tests to help diagnose peptic ulcers, find the cause, and check for complications. […] Doctors may use blood tests to check for signs of H. pylori infection or complications of peptic ulcers. […] Doctors may use a urea breath test to check for H. pylori infection. […] Doctors may use stool tests to check for H. pylori infection. […] Doctors may order an upper GI endoscopy to confirm the diagnosis of a peptic ulcer and try to find its cause. […] In some cases, doctors may order an upper GI series to help diagnose peptic ulcers or ulcer complications.

• #1 Diagnosis and Treatment of Peptic Ulcer Disease and H. pylori Infection | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0215/p236.html

  The most common causes of peptic ulcer disease (PUD) are Helicobacter pylori infection and use of nonsteroidal anti-inflammatory drugs (NSAIDs). […] The test-and-treat strategy for detecting H. pylori is appropriate in situations where the risk of gastric cancer is low based on age younger than 55 years and the absence of alarm symptoms. Most other patients should undergo upper endoscopy to rule out malignancy and other serious causes of dyspepsia. […] The American College of Gastroenterology (ACG) recommends testing for H. pylori infection in patients with active PUD or history of PUD, dyspepsia symptoms, or gastric MALT lymphoma. […] The test-and-treat strategy for detecting H. pylori is appropriate in patients with dyspepsia and low risk of gastric cancer (age younger than 55 years and no alarm symptoms such as unexplained weight loss, progressive dysphagia, odynophagia, recurrent vomiting, family history of gastrointestinal cancer, overt gastrointestinal bleeding, abdominal mass, iron deficiency anemia, or jaundice).

• #1 Diagnosis and Treatment of Peptic Ulcer Disease and H. pylori Infection | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0215/p236.html

  Endoscopy is recommended for patients who are 55 years or older, or who have alarm symptoms. […] The accuracy of diagnostic tests for H. pylori infection is summarized in Table 2. […] Urea breath tests require the ingestion of urea labeled with the nonradioactive isotope carbon 13 or carbon 14. […] Stool antigen tests using monoclonal antibodies are as accurate as urea breath tests if a validated laboratory-based monoclonal test is used. […] Serologic antibody testing detects immunoglobulin G specific to H. pylori in serum and cannot distinguish between an active infection and a past infection. […] Endoscopy with biopsy is recommended to rule out cancer and other serious causes in patients 55 years or older, or with one or more alarm symptoms.

• #1

  https://www.nhs.uk/conditions/stomach-ulcer/diagnosis/

  If a GP thinks you have a stomach ulcer, you may be tested for an Helicobacter pylori (H. pylori) infection. […] You may be referred to hospital for a procedure to look inside your stomach called a gastroscopy. […] If your GP thinks your symptoms are caused by an H. pylori infection, they may recommend one of the following tests: a urea breath test you’ll be given a drink containing urea (a chemical that’s broken down by H. pylori) and your breath is then checked after, a stool antigen test a small stool sample is tested for the bacteria, a blood test a sample of your blood is tested for antibodies to the H. pylori bacteria (antibodies are proteins produced naturally in your blood and help to fight infection); this has now largely been replaced by the stool antigen test. […] If you test positive for H. pylori, you’ll need treatment to clear it, which can heal the ulcer and prevent it returning. […] This is a test to look inside your stomach directly and see whether you have a stomach ulcer. […] The images taken by the camera will usually confirm or rule out an ulcer. A small tissue sample may also be taken from your stomach or duodenum so it can be tested for the H. pylori bacteria.

• #1 Peptic ulcer: Causes, diagnosis and management | Kenhub

  https://www.kenhub.com/en/library/pathology/peptic-ulcer

  Diagnosis can be made clinically, however for confirmation of diagnosis, investigations such as oesophago-gastro-duodenoscopy (OGD) and barium swallow abdominal x-rays can be carried out. Endoscopy is diagnostic test for peptic ulcer disease. If the patient is above the age of 45 with any of the alarm symptoms present or if symptoms do not resolve after a few weeks of treatment it is essential to investigate with endoscopy. […] When testing for H Pylori, the urea breath test is the gold standard for detecting H pylori because it is a rapid and non-invasive diagnostic technique. Blood tests to measure antibodies and stool antigen test can also be useful. A stool heme test is also an option to check for occult blood, this is usually negative. The CLO test (campylobacter like organism) is a biopsy test which detects the presence of H. Pylori in the stomach and duodenum. A biopsy is taken from the gastric antrum, and the tissue is placed onto a urea containing mediator. If H. Pylori is present, the indicator changes colour, as the urease produced by the bacteria converts the urea to ammonia, and hence the medium becomes more alkaline (the change is from yellow to red).

• #1 Peptic Ulcer Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK534792/

  Investigations: Esophagogastroduodenoscopy (EGD): Gold standard and most accurate diagnostic test with sensitivity and specificity up to 90% in diagnosing gastric and duodenal ulcers. […] Computerized tomography of the abdomen with contrast is of limited value in the diagnosis of PUD itself but is helpful in the diagnosis of its complications like perforation and gastric outlet obstruction.

• #1 Peptic ulcer – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/peptic-ulcer/diagnosis-treatment/drc-20354229

  Upper endoscopy During an upper endoscopy, a healthcare professional inserts a thin, flexible tube equipped with a light and camera down the throat and into the esophagus. The tiny camera provides a view of the esophagus, stomach and the beginning of the small intestine, called the duodenum. […] To detect an ulcer, your healthcare professional may first take a medical history and do a physical exam. You also may need tests, such as: […] Laboratory tests for H. pylori. A blood, stool or breath test can show whether H. pylori is in your body. […] Endoscopy. During this procedure, your healthcare professional uses a long, flexible tube with a tiny camera, called an endoscope, to look at the upper part of your digestive system. Endoscopy involves passing the endoscope, down your throat and into your esophagus, stomach and small intestine to look for ulcers.

• #1 Peptic ulcer – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/peptic-ulcer/diagnosis-treatment/drc-20354229

  You’re more likely to have endoscopy if you are older, have signs of bleeding, or have had recent weight loss or trouble eating and swallowing. If the endoscopy shows an ulcer in your stomach, you’re likely to have a follow-up endoscopy after treatment. This can show if the ulcer has healed. […] Upper gastrointestinal series. Sometimes called a barium swallow, this series of X-rays of the upper digestive system makes pictures of your esophagus, stomach and small intestine. During the series of X-rays, you swallow a white liquid that has barium. The liquid coats your digestive tract and makes an ulcer easier to see. […] Treatment for peptic ulcers often leads to ulcer healing. But if your symptoms are severe or if you have them even with treatment, your healthcare professional may suggest endoscopy. This procedure can rule out other possible causes for your symptoms.

• #1 Gastric Ulcer Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/368602-overview

  Peptic ulcers are mucosal breaks of 3 mm or greater and are common, occurring in about 10% of adults in Western countries. Gastric ulcers account for about one third of peptic ulcers, and duodenal ulcers account for the remainder. Because a small percentage (5%) of gastric ulcers are caused by ulcerated gastric carcinomas, all gastric ulcers must be carefully assessed to differentiate benign lesions from malignant lesions. With the decline of Helicobacter pylori infection, the detection of idiopathic peptic ulcer disease has become more frequent, making diagnosis and treatment more difficult. […] Fiberoptic endoscopy of the upper GI tract has become the diagnostic procedure of choice for patients with suspected duodenal ulcer. However, endoscopic examinations are more invasive and costly than double-contrast barium studies. Endoscopy with biopsy has a sensitivity of 95%, but multiple biopsy samples are needed to avoid sampling errors.

• #1

  https://link.springer.com/article/10.1007/BF01309382

  The introduction of fiberoptic endoscopy has altered the relative importance of ulcer symptoms in the diagnosis of peptic ulcer disease. […] Interestingly, we now realize that 50% of ulcer patients do not have the classical ulcer symptoms and that 25% of peptic ulcers are asymptomatic. Modern forward-viewing endoscopes of small diameter enable precise diagnosis with little discomfort in 95% of all duodenal ulcer patients. A biopsy is only recommended in rare cases (giant ulcers) because the malignancy rate is only 0.024% in duodenal ulcers. The diagnostic accuracy of endoscopy in detecting gastric ulcer is as high as that for duodenal ulcer, but for this ulcer type it is absolutely necessary to exclude malignancy by obtaining a minimum of six biopsies (four from the ulcer margin and two from the ulcer base), since approximately 10% of all gastric ulcers are actually carcinomas.

• #1 Gastric Ulcer Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/368602-overview

  The American Society of Gastrointestinal Endoscopy (ASGE) has published guidelines regarding endoscopy in patients with upper abdominal pain or dyspeptic symptoms that suggest peptic ulcer disease. The ASGE suggests that the decision to perform surveillance endoscopy in patients with a gastric ulcer be individualized. Surveillance endoscopy is suggested for patients with gastric ulcer who remain symptomatic despite an appropriate course of medical therapy. […] Single-contrast barium studies have an overall sensitivity of 75%, but double-contrast barium examinations have a sensitivity as high as 95% in the detection of gastric cancer. These results are comparable to those of endoscopy, and double-contrast barium examination remains a useful alternative to endoscopy. […] The World Society of Emergency Surgery (WSES) recommends the following for acute abdomen from suspected perforated peptic ulcer: CT scanning. Chest/abdominal radiograph as the initial routine diagnostic assessment in case a CT scan is not promptly available. When free air is not seen on imaging and there is ongoing suspicion of perforated peptic ulcer, imaging with the addition of water-soluble contrast either orally or via nasogastric tube.

• #1 Gastric Ulcer Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/368602-overview

  An upper GI series performed with water-soluble contrast agent may demonstrate the presence and site of the perforation and whether it has sealed. […] CT scanning has no part in the primary detection of gastric ulcers; however, this modality has a role in the detection of subphrenic and other collections that may occur after a perforation of a gastric ulcer. Direct signs of peptic ulcer disease on cross-sectional imaging include focal discontinuity of the mucosal hyperenhancement and identification of luminal outpouching. A useful indirect sign, which alerts to possible active inflammation and/or peptic ulcer, is edematous stranding of the periduodenal fat. […] Multidetector row CT (MDCT) scanning and three-dimensional (3D) imaging are expected to overcome the limitations in cancer staging by offering rapid and accurate information for space perception, detailed hemodynamics, and real-time 3D processing of volumetric data sets.

• #1 Peptic Ulcer Disease Workup: Approach Considerations, Endoscopy, Radiography

  https://emedicine.medscape.com/article/181753-workup

  Testing for H pylori infection is essential in all patients with peptic ulcers. Documentation of peptic ulcer disease depends on radiographic and endoscopic confirmation. […] If the diagnosis of peptic ulcer disease is suspected, obtaining a complete blood cell (CBC) count, liver function tests (LFTs), and levels of amylase and lipase may be useful. […] The 2017 American College of Gastroenterology (ACG) guidelines for the treatment of H pylori infection (HPI) include recommendations for testing for H pylori. […] The 2017 ACG guidelines also recommend posttreatment testing to prove eradication of HPI with the use of a urea breath test, fecal antigen test, or biopsy-based testing at least 4 weeks following the completion of antimicrobial therapy and after proton pump inhibitors have been withheld for 1-2 weeks.

• #1 Peptic Ulcer Disease | AAFP

  https://www.aafp.org/pubs/afp/issues/2007/1001/p1005.html

  Peptic ulcer disease usually occurs in the stomach and proximal duodenum. […] Older patients and patients with alarm symptoms indicating a complication or malignancy should have prompt endoscopy. […] For younger patients with no alarm symptoms, a test-and-treat strategy based on the results of H. pylori testing is recommended. […] If H. pylori infection is diagnosed, the infection should be eradicated and antisecretory therapy (preferably with a proton pump inhibitor) given for four weeks. […] Patients with persistent symptoms should be referred for endoscopy. […] The diagnosis of peptic ulcer disease is usually based on clinical features and specific testing, although it is important to be aware that individual signs and symptoms are relatively unreliable. […] Typical symptoms of peptic ulcer disease include episodic gnawing or burning epigastric pain; pain occurring two to five hours after meals or on an empty stomach; and nocturnal pain relieved by food intake, antacids, or antisecretory agents.

• #1 Peptic ulcer disease – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/peptic-ulcer-disease/

  Peptic ulcer disease (PUD) is the presence of one or more ulcerative lesions in the stomach or duodenum. […] Older patients and those with high-risk clinical features benefit from an esophagogastroduodenoscopy (EGD) and biopsies to confirm the diagnosis or rule out differential diagnoses (especially gastric cancer). […] The most accurate test to confirm the diagnosis is esophagogastroduodenoscopy (EGD). […] Alarm features warranting an EGD in younger patients include progressive dysphagia, odynophagia, rapid weight loss, persistent vomiting, suspected GI bleeding, and a family history of upper GI malignancy. […] Biopsies are recommended in most cases of gastric ulcers. […] To rule out gastric cancer, patients with suspicious gastric ulcers should undergo follow-up EGD and histology until the ulcer has healed completely!

• #1 An Overview on Peptic Ulcer Disease, Diagnosis and Management Approach – Pharmacophore

  https://pharmacophorejournal.com/article/an-overview-on-peptic-ulcer-disease-diagnosis-and-management-approach

  The most common complications of peptic ulcer disease are bleeding, perforation, and gastric outlet obstruction, respectively. […] The endoscopy is the gold standard in diagnosing and treating bleeding ulcers, acute upper gastrointestinal bleeding is the most common presentation of bleeding ulcer patients can also be associated with hypotensive shock and metabolic acidosis. […] A perforated peptic ulcer is less common than bleeding, but it has the highest mortality rate upon the complications with 30%; it is a medical emergency condition that requires a direct surgical intervention with no delaying because it has been approved that the delay increases the mortality probability. […] The diagnosis is made by upper endoscopy, and it mainly tends to rule out the malignancies since nowadays it is more common than the peptic ulcer complication. […] Peptic ulcer disease was very common in the past; nowadays, it is less common in high-income countries.

• #1 Gastric Ulcer Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/368602-overview

  Although endoscopy remains the standard of care, multidetector CT (MDCT) may prove useful in patients with suspected gastroduodenal bleeding. […] Hemorrhage occurs in 20-30% of ulcers. Endoscopy is the modality of choice for the investigation of hemorrhages, having a sensitivity of more than 90% in the detection of the bleeding site. […] The American College of Radiology (ACR) Appropriateness Criteria include the following imaging recommendations for identifying the source of upper GI bleeding (UGIB): When endoscopy identifies the presence and location of bleeding but bleeding cannot be controlled endoscopically, catheter-based arteriography with treatment is an appropriate next study. CT angiography (CTA) is comparable to angiography as a diagnostic next step. […] Perforation occurs in as many as 10% of patients with peptic ulcer disease but is less common in gastric ulcers.

• #1 Diagnosis and treatment of perforated or bleeding peptic ulcers: 2013 WSES position paper | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/1749-7922-9-45

  Prompt diagnosis of gastroduodenal perforation requires a high index of suspicion based on history and clinical examination. […] Free air under the diaphragm found on an upright chest X-ray is indicative of hollow organ perforation and mandates further work-up and/or exploration. […] The increased use of CT scans has greatly improved our ability to detect perforation. […] However, up to 12% of patients with traumatic perforations may have a normal CT scan. […] We suggest Erect CXR as initial routine diagnostic assessment in case of acute abdomen from suspected free perforation of PU. […] In case of negative AXR and/or erect CXR, we suggest CT scan as second level diagnostic tool since its higher sensitivity in detecting intra-abdominal free air. […] In case of negative findings of free intra-abdominal air and persistent suspicion of PPU, we suggest adding oral water soluble contrast or via NGT.

• #1 Peptic ulcer disease: Clinical manifestations and diagnosis – UpToDate

  https://www.uptodate.com/contents/peptic-ulcer-disease-clinical-manifestations-and-diagnosis

  Peptic ulcer disease: Clinical manifestations and diagnosis […] This topic will review the clinical manifestations and diagnosis of peptic ulcer disease. […] Upper endoscopy […] Indications for ulcer biopsy […] Biopsy for H. pylori […] Test and treat for Helicobacter pylori (H. pylori) infection […] Evaluate for nonsteroidal anti-inflammatory drug (NSAID) and corticosteroid use […] Peptic ulcers may present with dyspeptic or other gastrointestinal symptoms or may be initially asymptomatic and then present with complications such as hemorrhage or perforation. […] Approximately 70 percent of peptic ulcers are asymptomatic. […] Patients with silent peptic ulcers may later present with ulcer-related complications such as hemorrhage or perforation. […] Upper abdominal pain or discomfort is the most prominent symptom in patients with peptic ulcers. […] Approximately 80 percent of patients with endoscopically diagnosed ulcers have epigastric pain. […] Patients may have associated symptoms of bloating, abdominal fullness, nausea, and early satiety that may be provoked by eating.

• #1 Peptic ulcer – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/peptic-ulcer/diagnosis-treatment/drc-20354229

  If your healthcare professional finds an ulcer during endoscopy, you may need another endoscopy after your treatment to make sure your ulcer has healed. […] Peptic ulcers that don’t heal with treatment are called refractory ulcers. Reasons for an ulcer not healing include: Not taking medicines as prescribed. […] Treatment for refractory ulcers most often involves getting rid of factors that keep the ulcer from healing and trying other antibiotics. If you smoke, your healthcare professional may suggest you quit. Smoking can slow ulcer healing.

• #1 Peptic Ulcer Disease Sidelines Springsteen: What Is PUD and How Is It Treated?

  https://news.cuanschutz.edu/news-stories/peptic-ulcer-disease-sidelines-springsteen-what-is-pud-and-how-is-it-treated

  Peptic ulcer disease (PUD) is a disruption in the top layer of tissue in the digestive tract. […] The most sensitive and specific way of diagnosing peptic ulcer disease is through endoscopic evaluation where you visualize the tissue in the stomach and the small intestine. PUD can also be diagnosed with a barium X-ray that evaluates the mucosa for an ulcer defect. Sometimes patients present with abdominal pain and end up getting a CT scan that shows there may be an ulcer in the stomach or small intestine, seeing inflammatory changes in the area. […] Based on those suspicions, we’ll move forward to an endoscopy to evaluate for an ulcer. Well take stomach biopsies to see if there is an H. pylori infection and get a detailed medical history to see if the patient is on NSAIDs. […] The most common medication that we use to heal these ulcers are proton-pump inhibitors, which are acid-blocker medications, and we generally put patients on a high PPI dose of 40 mg twice daily. Patients will be on high dose PPI for usually six to eight weeks. […] If a patient had a gastric ulcer, we repeat the upper endoscopy 6-8 weeks after the diagnosis of PUD to make sure the ulcer is healed. We dont repeat an upper endoscopy for duodenal ulcers.

• #1 Peptic Ulcer: Causes, Treatment, and Prevention

  https://www.healthline.com/health/peptic-ulcer

  Because H. pylori is a cause of peptic ulcers, your doctor will also run a test to check for this infection in your stomach. […] If tests show that you have an H. pylori infection, your doctor will prescribe a combination of medication. […] Your doctor may also prescribe sucralfate (Carafate) which will coat your stomach and reduce symptoms of peptic ulcers. […] If your ulcer doesnt heal with the initial treatment, this can indicate: an excessive production of stomach acid, presence of bacteria other than H. pylori in the stomach, another disease, such as stomach cancer or Crohns disease. […] Your doctor may offer a different method of treatment or run additional tests to rule out stomach cancer and other gastrointestinal diseases.

• #1 Stomach Ulcer: Signs, Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/22314-stomach-ulcer

  Your provider can use these tools to take a tissue sample (biopsy) and test it for H. pylori. […] Although endoscopy is the best method, sometimes an imaging test like an upper GI X-ray series can identify a stomach ulcer without going inside your stomach. […] If you can make it go away without treatment for example, if your ulcer is due to NSAID use and you stop taking NSAIDs this might be enough for the ulcer to heal by itself. […] Healthcare providers treat most ulcers with a combination of medications to reduce stomach acid, coat and protect the ulcer during healing, and kill any infection involved. […] If you have a complicated ulcer, your provider may need to treat it directly. […] They can usually do this during your endoscopy exam. […] Always seek medical care for a stomach ulcer. […] You need to address the underlying cause. […] An untreated ulcer can lead to serious complications, even if you dont have severe symptoms.

• #2 An Overview on Peptic Ulcer Disease, Diagnosis and Management Approach – Pharmacophore

  https://pharmacophorejournal.com/article/an-overview-on-peptic-ulcer-disease-diagnosis-and-management-approach

  Peptic ulcer disease is one of the most common complaints in the medical field. […] The treatment mainly to treat the underlying cause if it is the H.pylori or NSAID. […] The objective of this review is to discuss Peptic Ulcer Disease, different presentations, and management plans with the outcome. […] In this review, we will discuss the diagnosing procedure hand to hand with the management plan for peptic ulcers and its complication. […] In terms of diagnosing peptic ulcer disease, the upper endoscopy has the upper hand on other procedures, and it is considered to be the gold standard in diagnosing steps since it can exclude any other malignant diseases and can confirm peptic or duodenal ulcers in addition to biopsy sometimes. […] To confirm H.Pylori infection, usually, the physician uses a urea breath test or stool antigen test to confirm or role out H.plori infection.

• #2 Stomach Ulcer: Signs, Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/22314-stomach-ulcer

  A stomach ulcer occurs when stomach acid eats through your protective stomach lining, producing an open sore. […] A healthcare provider must identify the cause of your ulcer to recommend the right treatment. […] Your healthcare provider will begin by asking you about your symptoms and medical history. […] If signs point to an ulcer, theyll take a look inside your stomach to find it. […] Your healthcare provider will want to check for H. pylori infection, then look for the ulcer itself inside your stomach. […] They can do these things in a few different ways. One common method is an upper endoscopy exam, which can accomplish both at once. […] An upper endoscopy (EGD test) goes inside your stomach with a tiny camera on a long, thin tube (endoscope). […] Through the tube, a healthcare provider can pass long, narrow tools.

• #2 Peptic ulcer disease – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/3000205

  Peptic ulcer disease usually presents as chronic, upper abdominal pain related to eating a meal (dyspepsia). […] Endoscopy is diagnostic and may show an ulcer in the stomach or proximal duodenum. […] History and exam […] Key diagnostic factors […] abdominal pain […] presence of risk factors […] 'pointing sign’ […] Other diagnostic factors […] epigastric tenderness […] nausea or vomiting […] early satiety […] weight loss or anorexia […] diarrhoea […] symptoms of anaemia […] gastrointestinal bleeding […] hypotension or septic shock […] succussion splash […] Diagnostic investigations […] 1st investigations to order […] upper gastrointestinal endoscopy […] Helicobacter pylori carbon-13 urea breath test or stool antigen test […] FBC.

• #2 Peptic Ulcer Disease: Causes and Treatment | Doctor

  https://patient.info/doctor/peptic-ulcer-disease

  The NICE guideline for suspected cancer states for stomach cancer: Consider a suspected cancer pathway referral for people with an upper abdominal mass consistent with stomach cancer. […] Offer urgent, direct access upper gastrointestinal endoscopy (to be done within 2 weeks) to assess for stomach cancer in people with dysphagia, or aged 55 and over with weight loss and any of the following: upper abdominal pain, reflux, or dyspepsia. […] Consider non-urgent, direct access upper gastrointestinal endoscopy to assess for stomach cancer in people with haematemesis. […] Consider non-urgent, direct access upper gastrointestinal endoscopy to assess for stomach cancer in people aged 55 or over with: Treatment-resistant dyspepsia or Upper abdominal pain with low haemoglobin levels or Raised platelet count with any of the following: nausea, vomiting, weight loss, reflux, dyspepsia, upper abdominal pain, or Nausea or vomiting with any of the following: weight loss, reflux, dyspepsia, upper abdominal pain.

• #2 Peptic Ulcer Disease Workup: Approach Considerations, Endoscopy, Radiography

  https://emedicine.medscape.com/article/181753-workup

  Testing for H pylori infection is essential in all patients with peptic ulcers. Documentation of peptic ulcer disease depends on radiographic and endoscopic confirmation. […] If the diagnosis of peptic ulcer disease is suspected, obtaining a complete blood cell (CBC) count, liver function tests (LFTs), and levels of amylase and lipase may be useful. […] The 2017 American College of Gastroenterology (ACG) guidelines for the treatment of H pylori infection (HPI) include recommendations for testing for H pylori. […] The 2017 ACG guidelines also recommend posttreatment testing to prove eradication of HPI with the use of a urea breath test, fecal antigen test, or biopsy-based testing at least 4 weeks following the completion of antimicrobial therapy and after proton pump inhibitors have been withheld for 1-2 weeks.

• #2 A pilot study of non-invasive diagnostic tools to detect Helicobacter pylori infection and peptic ulcer disease | Scientific Reports

  https://www.nature.com/articles/s41598-023-50266-2

  Helicobacter pylori (H. pylori) infection can lead to various digestive system diseases, making accurate diagnosis crucial. […] This study aimed to compare the efficacy of non-invasive and invasive diagnostic tools for H. pylori infection and assess their correlation with esophagogastroduodenoscopic (EGD) findings. […] The study utilized the Campylobacter-Like Organism (CLO) test, serum anti-HP IgG blood test, and C-13-urea breath test (UBT) to diagnose H. pylori infection. […] Among the participants, 74.0% were diagnosed with peptic ulcer disease through EGD. […] The UBT demonstrated the highest Youden’s index, ranging from 58 to 100%, against all the non-invasive tests. […] The IgG blood test displayed the highest sensitivity at 100%, with a specificity of 60-70%.

• #2 Diagnosis and Treatment of Peptic Ulcer Disease and H. pylori Infection | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0215/p236.html

  Endoscopy is recommended for patients who are 55 years or older, or who have alarm symptoms. […] The accuracy of diagnostic tests for H. pylori infection is summarized in Table 2. […] Urea breath tests require the ingestion of urea labeled with the nonradioactive isotope carbon 13 or carbon 14. […] Stool antigen tests using monoclonal antibodies are as accurate as urea breath tests if a validated laboratory-based monoclonal test is used. […] Serologic antibody testing detects immunoglobulin G specific to H. pylori in serum and cannot distinguish between an active infection and a past infection. […] Endoscopy with biopsy is recommended to rule out cancer and other serious causes in patients 55 years or older, or with one or more alarm symptoms.

• #2 Stomach Ulcer: Signs, Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/22314-stomach-ulcer

  Your provider can use these tools to take a tissue sample (biopsy) and test it for H. pylori. […] Although endoscopy is the best method, sometimes an imaging test like an upper GI X-ray series can identify a stomach ulcer without going inside your stomach. […] If you can make it go away without treatment for example, if your ulcer is due to NSAID use and you stop taking NSAIDs this might be enough for the ulcer to heal by itself. […] Healthcare providers treat most ulcers with a combination of medications to reduce stomach acid, coat and protect the ulcer during healing, and kill any infection involved. […] If you have a complicated ulcer, your provider may need to treat it directly. […] They can usually do this during your endoscopy exam. […] Always seek medical care for a stomach ulcer. […] You need to address the underlying cause. […] An untreated ulcer can lead to serious complications, even if you dont have severe symptoms.

• #2 Peptic Ulcer Disease (PUD): Diagnosis and Treatment – The ObG Project

  https://www.obgproject.com/2021/05/24/peptic-ulcer-disease-pud-diagnosis-and-treatment/

  Peptic Ulcer Disease (PUD) is a common cause of epigastric pain. […] Helicobacter pylori testing is recommended for all patients and, if positive, treatment with a proton pump inhibitor (PPI) based triple therapy usually manages most symptoms. […] Patients reporting the common symptoms, such as epigastric pain, abdominal fullness, and bloating, should raise suspicion for PUD. […] Any patient presenting with alarm symptoms listed above should be investigated further. […] Esophagogastroduodenoscopy (EGD) is the gold standard for diagnosis. […] The American Society of Gastrointestinal Endoscopy guidelines recommend an EGD for patients >60 years of age and new onset of dyspeptic symptoms. […] Helicobacter pylori testing should be obtained when PUD is suspected and eradication should be confirmed after treatment. […] Blood work should include CBC, liver function, amylase level and lipase. […] Abdominal CT with contrast may be used to investigate for complications such as perforation or gastric outlet obstruction.

• #2 Peptic Ulcer Disease Workup: Approach Considerations, Endoscopy, Radiography

  https://emedicine.medscape.com/article/181753-workup

  Upper gastrointestinal (GI) endoscopy is the preferred diagnostic test in the evaluation of patients with suspected peptic ulcer disease. […] It is highly sensitive for the diagnosis of gastric and duodenal ulcers, allows for biopsies and cytologic brushings in the setting of a gastric ulcer to differentiate a benign ulcer from a malignant lesion, and allows for the detection of H pylori infection with antral biopsies for a rapid urease test and/or histopathology in patients with peptic ulcer disease. […] An upper GI series is not as sensitive as endoscopy for establishing a diagnosis of small ulcers ( 0.5 cm). […] A fasting serum gastrin level should be obtained in certain cases to screen for Zollinger-Ellison syndrome. […] A secretin stimulation test may be required if the diagnosis of Zollinger-Ellison syndrome cannot be made on the basis of the serum gastrin level alone.

• #2 Peptic Ulcer Disease | AAFP

  https://www.aafp.org/pubs/afp/issues/2007/1001/p1005.html

  A history of episodic or epigastric pain, relief of pain after food intake, and nighttime awakening because of pain with relief following food intake are the most specific findings for peptic ulcer and help rule in the diagnosis. […] Patients older than 55 years and those with alarm symptoms should be referred for prompt upper endoscopy. […] Esophagogastroduodenoscopy (EGD) is more sensitive and specific for peptic ulcer disease than upper gastrointestinal barium studies and allows biopsy of gastric lesions. […] If test results are positive for H. pylori, the infection should be eradicated and antisecretory therapy, preferably with a proton pump inhibitor, administered for four weeks. […] Further management is based on the endoscopic or radiologic diagnosis.

• #2

  https://link.springer.com/article/10.1007/BF01309382

  The introduction of fiberoptic endoscopy has altered the relative importance of ulcer symptoms in the diagnosis of peptic ulcer disease. […] Interestingly, we now realize that 50% of ulcer patients do not have the classical ulcer symptoms and that 25% of peptic ulcers are asymptomatic. Modern forward-viewing endoscopes of small diameter enable precise diagnosis with little discomfort in 95% of all duodenal ulcer patients. A biopsy is only recommended in rare cases (giant ulcers) because the malignancy rate is only 0.024% in duodenal ulcers. The diagnostic accuracy of endoscopy in detecting gastric ulcer is as high as that for duodenal ulcer, but for this ulcer type it is absolutely necessary to exclude malignancy by obtaining a minimum of six biopsies (four from the ulcer margin and two from the ulcer base), since approximately 10% of all gastric ulcers are actually carcinomas.

• #2 Peptic Ulcer Disease Workup: Approach Considerations, Endoscopy, Radiography

  https://emedicine.medscape.com/article/181753-workup

  A single biopsy offers 70% accuracy in diagnosing gastric cancer, but 7 biopsy samples obtained from the base and ulcer margins increase the sensitivity to 99%. […] The emergency department (ED) workup will vary depending on presentation and includes the following: Complete blood cell (CBC) count is used to evaluate acute or chronic blood loss.

• #2 Gastric Ulcer Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/368602-overview

  The American Society of Gastrointestinal Endoscopy (ASGE) has published guidelines regarding endoscopy in patients with upper abdominal pain or dyspeptic symptoms that suggest peptic ulcer disease. The ASGE suggests that the decision to perform surveillance endoscopy in patients with a gastric ulcer be individualized. Surveillance endoscopy is suggested for patients with gastric ulcer who remain symptomatic despite an appropriate course of medical therapy. […] Single-contrast barium studies have an overall sensitivity of 75%, but double-contrast barium examinations have a sensitivity as high as 95% in the detection of gastric cancer. These results are comparable to those of endoscopy, and double-contrast barium examination remains a useful alternative to endoscopy. […] The World Society of Emergency Surgery (WSES) recommends the following for acute abdomen from suspected perforated peptic ulcer: CT scanning. Chest/abdominal radiograph as the initial routine diagnostic assessment in case a CT scan is not promptly available. When free air is not seen on imaging and there is ongoing suspicion of perforated peptic ulcer, imaging with the addition of water-soluble contrast either orally or via nasogastric tube.

• #2 How Peptic Ulcer Disease Is Diagnosed

  https://www.verywellhealth.com/peptic-ulcer-disease-diagnosis-4707600

  If the cause of peptic ulcers isn’t related to H. pylori, your healthcare provider may perform some imaging tests in order to see the contents of your stomach and intestine. […] With an endoscopy, a small tube with a lens (called an endoscope) is inserted into your throat to view your esophagus, small intestine, and stomach. […] Commonly referred to as a barium swallow, this imaging test is performed if someone is experiencing severe peptic ulcer symptoms, like stomach pain with vomiting, weight loss, or difficulty swallowing. […] For the CT scan, you will drink a solution called a contrast medium, then lay on a table that slides into a tunnel-shaped machine. […] Your healthcare provider may also consider other causes for your symptoms. […] There are several tests available to help diagnose peptic ulcer disease. […] If you think you may have peptic ulcer disease, talk to a healthcare provider to get an accurate diagnosis.

• #2 Gastric Ulcer Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/368602-overview

  An upper GI series performed with water-soluble contrast agent may demonstrate the presence and site of the perforation and whether it has sealed. […] CT scanning has no part in the primary detection of gastric ulcers; however, this modality has a role in the detection of subphrenic and other collections that may occur after a perforation of a gastric ulcer. Direct signs of peptic ulcer disease on cross-sectional imaging include focal discontinuity of the mucosal hyperenhancement and identification of luminal outpouching. A useful indirect sign, which alerts to possible active inflammation and/or peptic ulcer, is edematous stranding of the periduodenal fat. […] Multidetector row CT (MDCT) scanning and three-dimensional (3D) imaging are expected to overcome the limitations in cancer staging by offering rapid and accurate information for space perception, detailed hemodynamics, and real-time 3D processing of volumetric data sets.

• #2 Non-perforated peptic ulcer disease: multidetector CT findings, complications, and differential diagnosis | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1007/s13244-017-0562-5

  Despite availability of effective therapies, peptic ulcer disease (PUD) remains a major global disease, resulting from a combination of persistent Helicobacter pylori infection and widespread use of nonsteroidal anti-inflammatory drugs. […] Albeit endoscopy definitely represents the mainstay diagnostic technique, patients presenting to emergency departments with unexplained abdominal pain generally undergo multidetector CT as an initial investigation. […] This pictorial essay aims to provide radiologists with an increased familiarity with CT diagnosis of non-perforated PUD, with emphasis on differential diagnosis. […] Upper digestive endoscopy is definitely the mainstay diagnostic technique for PUD, but is invasive and often unfeasible in urgent conditions unless gastrointestinal bleeding is suspected.

• #2 Diagnosis and Treatment of Peptic Ulcer Disease and H. pylori Infection | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0215/p236.html

  The most common causes of peptic ulcer disease (PUD) are Helicobacter pylori infection and use of nonsteroidal anti-inflammatory drugs (NSAIDs). […] The test-and-treat strategy for detecting H. pylori is appropriate in situations where the risk of gastric cancer is low based on age younger than 55 years and the absence of alarm symptoms. Most other patients should undergo upper endoscopy to rule out malignancy and other serious causes of dyspepsia. […] The American College of Gastroenterology (ACG) recommends testing for H. pylori infection in patients with active PUD or history of PUD, dyspepsia symptoms, or gastric MALT lymphoma. […] The test-and-treat strategy for detecting H. pylori is appropriate in patients with dyspepsia and low risk of gastric cancer (age younger than 55 years and no alarm symptoms such as unexplained weight loss, progressive dysphagia, odynophagia, recurrent vomiting, family history of gastrointestinal cancer, overt gastrointestinal bleeding, abdominal mass, iron deficiency anemia, or jaundice).

• #2 Peptic Ulcer Disease | AAFP

  https://www.aafp.org/pubs/afp/issues/2007/1001/p1005.html

  Peptic ulcer disease usually occurs in the stomach and proximal duodenum. […] Older patients and patients with alarm symptoms indicating a complication or malignancy should have prompt endoscopy. […] For younger patients with no alarm symptoms, a test-and-treat strategy based on the results of H. pylori testing is recommended. […] If H. pylori infection is diagnosed, the infection should be eradicated and antisecretory therapy (preferably with a proton pump inhibitor) given for four weeks. […] Patients with persistent symptoms should be referred for endoscopy. […] The diagnosis of peptic ulcer disease is usually based on clinical features and specific testing, although it is important to be aware that individual signs and symptoms are relatively unreliable. […] Typical symptoms of peptic ulcer disease include episodic gnawing or burning epigastric pain; pain occurring two to five hours after meals or on an empty stomach; and nocturnal pain relieved by food intake, antacids, or antisecretory agents.

• #2 Peptic ulcer disease – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/peptic-ulcer-disease/

  Consider testing for rare causes if the etiology remains unclear or the patient presents with recurrent ulcers. […] Esophagogastroduodenoscopy (EGD) is the most accurate test to confirm the diagnosis. […] The diagnostic approach for suspected PUD includes screening for common etiologies on history, e.g., NSAID use. […] Patients 60 years of age without red flags for dyspepsia should begin with noninvasive testing for H. pylori infection. […] Patients with red flags for dyspepsia should be referred directly for EGD (or other indicated diagnostic study).

• #2 Peptic Ulcer Symptoms, Diagnosis, and Treatment | ACE Specialist Clinic

  https://acesurgery.sg/24-7-emergency/acute-peptic-ulcer-complications/

  How are the complications diagnosed? […] To identify an ulcer, your general surgeon will need to understand your medical history and conduct a physical examination. […] Laboratory tests can detect peptic ulcer complications. […] Your general surgeon might suggest tests to detect the presence of H. pylori bacterium in your body. […] Your general surgeon may perform an endoscopy to examine your upper digestive system, checking for ulcers by inserting a hollow tube with a camera down your throat. […] During endoscopy, a biopsy may be taken to rule out gastric cancer or infection with Helicobacter pylori. […] Also known as a barium swallow, this series of X-rays captures images of your oesophagus, stomach, and small intestine. […] If left untreated, peptic ulcers often lead to complications.

• #2 An Overview on Peptic Ulcer Disease, Diagnosis and Management Approach – Pharmacophore

  https://pharmacophorejournal.com/article/an-overview-on-peptic-ulcer-disease-diagnosis-and-management-approach

  The most common complications of peptic ulcer disease are bleeding, perforation, and gastric outlet obstruction, respectively. […] The endoscopy is the gold standard in diagnosing and treating bleeding ulcers, acute upper gastrointestinal bleeding is the most common presentation of bleeding ulcer patients can also be associated with hypotensive shock and metabolic acidosis. […] A perforated peptic ulcer is less common than bleeding, but it has the highest mortality rate upon the complications with 30%; it is a medical emergency condition that requires a direct surgical intervention with no delaying because it has been approved that the delay increases the mortality probability. […] The diagnosis is made by upper endoscopy, and it mainly tends to rule out the malignancies since nowadays it is more common than the peptic ulcer complication. […] Peptic ulcer disease was very common in the past; nowadays, it is less common in high-income countries.

• #2 Gastric Ulcer Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/368602-overview

  Although endoscopy remains the standard of care, multidetector CT (MDCT) may prove useful in patients with suspected gastroduodenal bleeding. […] Hemorrhage occurs in 20-30% of ulcers. Endoscopy is the modality of choice for the investigation of hemorrhages, having a sensitivity of more than 90% in the detection of the bleeding site. […] The American College of Radiology (ACR) Appropriateness Criteria include the following imaging recommendations for identifying the source of upper GI bleeding (UGIB): When endoscopy identifies the presence and location of bleeding but bleeding cannot be controlled endoscopically, catheter-based arteriography with treatment is an appropriate next study. CT angiography (CTA) is comparable to angiography as a diagnostic next step. […] Perforation occurs in as many as 10% of patients with peptic ulcer disease but is less common in gastric ulcers.

• #2 Peptic ulcer disease: Clinical manifestations and diagnosis – UpToDate

  https://www.uptodate.com/contents/peptic-ulcer-disease-clinical-manifestations-and-diagnosis/print

  Peptic ulcer disease: Clinical manifestations and diagnosis […] This topic will review the clinical manifestations and diagnosis of peptic ulcer disease. […] Patients with silent peptic ulcers may later present with ulcer-related complications such as hemorrhage or perforation. […] Approximately 80 percent of patients with endoscopically diagnosed ulcers have epigastric pain. […] In one systematic review that included 33 studies of patients with endoscopically diagnosed peptic ulcer disease, the average prevalence of heartburn or acid regurgitation was 46 percent.

• #2

  https://www.nhs.uk/conditions/stomach-ulcer/diagnosis/

  If a GP thinks you have a stomach ulcer, you may be tested for an Helicobacter pylori (H. pylori) infection. […] You may be referred to hospital for a procedure to look inside your stomach called a gastroscopy. […] If your GP thinks your symptoms are caused by an H. pylori infection, they may recommend one of the following tests: a urea breath test you’ll be given a drink containing urea (a chemical that’s broken down by H. pylori) and your breath is then checked after, a stool antigen test a small stool sample is tested for the bacteria, a blood test a sample of your blood is tested for antibodies to the H. pylori bacteria (antibodies are proteins produced naturally in your blood and help to fight infection); this has now largely been replaced by the stool antigen test. […] If you test positive for H. pylori, you’ll need treatment to clear it, which can heal the ulcer and prevent it returning. […] This is a test to look inside your stomach directly and see whether you have a stomach ulcer. […] The images taken by the camera will usually confirm or rule out an ulcer. A small tissue sample may also be taken from your stomach or duodenum so it can be tested for the H. pylori bacteria.

• #2

  https://link.springer.com/article/10.1007/BF01309382

  Whereas in duodenal ulcer repeat endoscopy is seldom necessary, it is mandatory in gastric ulcer since ulcer healing is not proof of a benign ulcer. In experienced hands endoscopy is superior to radiography in duodenal and in gastric ulcer, although there is still a place for radiography as a supplementary investigation or if the patient rejects endoscopy. When selecting patients for treatment of peptic ulcer the following aspects must be considered: natural history of the disease, effectiveness of treatment, and risks and costs of treatment. Treatment goals (relief of symptoms, ulcer healing) can be achieved as far as the acute ulcer is concerned but as yet we have no evidence that we can cure chronic ulcer disease.

• #2 Peptic Ulcer: Causes, Treatment, and Prevention

  https://www.healthline.com/health/peptic-ulcer

  Because H. pylori is a cause of peptic ulcers, your doctor will also run a test to check for this infection in your stomach. […] If tests show that you have an H. pylori infection, your doctor will prescribe a combination of medication. […] Your doctor may also prescribe sucralfate (Carafate) which will coat your stomach and reduce symptoms of peptic ulcers. […] If your ulcer doesnt heal with the initial treatment, this can indicate: an excessive production of stomach acid, presence of bacteria other than H. pylori in the stomach, another disease, such as stomach cancer or Crohns disease. […] Your doctor may offer a different method of treatment or run additional tests to rule out stomach cancer and other gastrointestinal diseases.

• #2 Peptic ulcer – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/peptic-ulcer/diagnosis-treatment/drc-20354229

  If your healthcare professional finds an ulcer during endoscopy, you may need another endoscopy after your treatment to make sure your ulcer has healed. […] Peptic ulcers that don’t heal with treatment are called refractory ulcers. Reasons for an ulcer not healing include: Not taking medicines as prescribed. […] Treatment for refractory ulcers most often involves getting rid of factors that keep the ulcer from healing and trying other antibiotics. If you smoke, your healthcare professional may suggest you quit. Smoking can slow ulcer healing.

• #2 Peptic Ulcer Disease Sidelines Springsteen: What Is PUD and How Is It Treated?

  https://news.cuanschutz.edu/news-stories/peptic-ulcer-disease-sidelines-springsteen-what-is-pud-and-how-is-it-treated

  Peptic ulcer disease (PUD) is a disruption in the top layer of tissue in the digestive tract. […] The most sensitive and specific way of diagnosing peptic ulcer disease is through endoscopic evaluation where you visualize the tissue in the stomach and the small intestine. PUD can also be diagnosed with a barium X-ray that evaluates the mucosa for an ulcer defect. Sometimes patients present with abdominal pain and end up getting a CT scan that shows there may be an ulcer in the stomach or small intestine, seeing inflammatory changes in the area. […] Based on those suspicions, we’ll move forward to an endoscopy to evaluate for an ulcer. Well take stomach biopsies to see if there is an H. pylori infection and get a detailed medical history to see if the patient is on NSAIDs. […] The most common medication that we use to heal these ulcers are proton-pump inhibitors, which are acid-blocker medications, and we generally put patients on a high PPI dose of 40 mg twice daily. Patients will be on high dose PPI for usually six to eight weeks. […] If a patient had a gastric ulcer, we repeat the upper endoscopy 6-8 weeks after the diagnosis of PUD to make sure the ulcer is healed. We dont repeat an upper endoscopy for duodenal ulcers.

• #3 A pilot study of non-invasive diagnostic tools to detect Helicobacter pylori infection and peptic ulcer disease | Scientific Reports

  https://www.nature.com/articles/s41598-023-50266-2

  On the other hand, the CLO test exhibited the highest specificity at 100% and a sensitivity of 50-85%. […] The IgG blood test holds promise as a primary screening tool due to its exceptional sensitivity. […] While the UBT is relatively expensive, its non-invasive nature and high sensitivity and specificity make it a potential standalone diagnostic test for H. pylori infection. […] The accuracy of non-invasive diagnostic tests for H. pylori infection is influenced by patient-related factors and technical considerations. […] Patient preferences play a crucial role in selecting diagnostic tests for H. pylori infection and peptic ulcer disease. […] Non-invasive tests, such as the Urea Breath Test (UBT) or serological tests, often enjoy higher acceptability compared to invasive methods, mitigating discomfort and anxiety.

• #3 Peptic Ulcer Disease – American College of Gastroenterology

  https://gi.org/topics/peptic-ulcer-disease/

  An “ulcer” is an open sore. The word “peptic” means that the cause of the problem is due to acid. Most of the time when a gastroenterologist is referring to an “ulcer” the doctor means a peptic ulcer. […] The most typical way for ulcers to be diagnosed is by a procedure called an EGD. EGD stands for EsophagoGastroDuodenoscopy. An EGD (also called “upper endoscopy”) is performed by inserting a special lighted camera on a flexible tube into the person’s mouth to look directly into the stomach and the beginning of the small bowel. This flexible camera carefully inspects the most likely areas for ulcers to be located. Ulcers identified during an EGD may be photographed, biopsied and even treated, if bleeding is present. […] Today, the preferred method for diagnosing ulcers is with an EGD given the flexible camera is better able to detect even small ulcers and because it allows for potential treatment at that time if the ulcer is bleeding. An upper GI series can miss small ulcers and also does not allow direct treatment of an ulcer.

• #3 Peptic ulcer disease – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/peptic-ulcer-disease/

  Peptic ulcer disease (PUD) is the presence of one or more ulcerative lesions in the stomach or duodenum. […] Older patients and those with high-risk clinical features benefit from an esophagogastroduodenoscopy (EGD) and biopsies to confirm the diagnosis or rule out differential diagnoses (especially gastric cancer). […] The most accurate test to confirm the diagnosis is esophagogastroduodenoscopy (EGD). […] Alarm features warranting an EGD in younger patients include progressive dysphagia, odynophagia, rapid weight loss, persistent vomiting, suspected GI bleeding, and a family history of upper GI malignancy. […] Biopsies are recommended in most cases of gastric ulcers. […] To rule out gastric cancer, patients with suspicious gastric ulcers should undergo follow-up EGD and histology until the ulcer has healed completely!

• #3

  https://link.springer.com/article/10.1007/BF01309382

  Whereas in duodenal ulcer repeat endoscopy is seldom necessary, it is mandatory in gastric ulcer since ulcer healing is not proof of a benign ulcer. In experienced hands endoscopy is superior to radiography in duodenal and in gastric ulcer, although there is still a place for radiography as a supplementary investigation or if the patient rejects endoscopy. When selecting patients for treatment of peptic ulcer the following aspects must be considered: natural history of the disease, effectiveness of treatment, and risks and costs of treatment. Treatment goals (relief of symptoms, ulcer healing) can be achieved as far as the acute ulcer is concerned but as yet we have no evidence that we can cure chronic ulcer disease.

• #3 Diagnosis and treatment of perforated or bleeding peptic ulcers: 2013 WSES position paper | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/1749-7922-9-45

  Prompt diagnosis of gastroduodenal perforation requires a high index of suspicion based on history and clinical examination. […] Free air under the diaphragm found on an upright chest X-ray is indicative of hollow organ perforation and mandates further work-up and/or exploration. […] The increased use of CT scans has greatly improved our ability to detect perforation. […] However, up to 12% of patients with traumatic perforations may have a normal CT scan. […] We suggest Erect CXR as initial routine diagnostic assessment in case of acute abdomen from suspected free perforation of PU. […] In case of negative AXR and/or erect CXR, we suggest CT scan as second level diagnostic tool since its higher sensitivity in detecting intra-abdominal free air. […] In case of negative findings of free intra-abdominal air and persistent suspicion of PPU, we suggest adding oral water soluble contrast or via NGT.

• #3 Non-perforated peptic ulcer disease: multidetector CT findings, complications, and differential diagnosis | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1007/s13244-017-0562-5

  As a result, many patients with unknown PUD present to emergency departments with unexplained acute abdomen and commonly undergo multidetector CT. […] Albeit superficial ulcers are generally inconspicuous, careful multiplanar CT interpretation and attention to subtle mural and extraluminal signs may allow diagnosing non-perforated PUD prospectively. […] Therefore, this pictorial essay aims to provide radiologists with an increased familiarity with CT appearances of non-perforated PUD. […] The CT diagnosis of PUD relies on a combination of direct and indirect signs. […] Literature from the multidetector CT era reported sensitivities of CT for ulcers of 29.6% to 54%, with an average size of 25 mm for visible ulcers compared to 16 mm of missed ones. […] Albeit not the diagnostic technique of choice for suspected PUD, multidetector CT may allow aware radiologists to diagnose both uncomplicated PUD and complications such as haemorrhage, GOO, and biliary or pancreatic fistulisation, thus allowing for timely appropriate treatment.

• #3 Peptic Ulcer Disease (PUD): Diagnosis and Treatment – The ObG Project

  https://www.obgproject.com/2021/05/24/peptic-ulcer-disease-pud-diagnosis-and-treatment/

  Peptic Ulcer Disease (PUD) is a common cause of epigastric pain. […] Helicobacter pylori testing is recommended for all patients and, if positive, treatment with a proton pump inhibitor (PPI) based triple therapy usually manages most symptoms. […] Patients reporting the common symptoms, such as epigastric pain, abdominal fullness, and bloating, should raise suspicion for PUD. […] Any patient presenting with alarm symptoms listed above should be investigated further. […] Esophagogastroduodenoscopy (EGD) is the gold standard for diagnosis. […] The American Society of Gastrointestinal Endoscopy guidelines recommend an EGD for patients >60 years of age and new onset of dyspeptic symptoms. […] Helicobacter pylori testing should be obtained when PUD is suspected and eradication should be confirmed after treatment. […] Blood work should include CBC, liver function, amylase level and lipase. […] Abdominal CT with contrast may be used to investigate for complications such as perforation or gastric outlet obstruction.

• #3 Peptic ulcer disease – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/peptic-ulcer-disease/

  Consider testing for rare causes if the etiology remains unclear or the patient presents with recurrent ulcers. […] Esophagogastroduodenoscopy (EGD) is the most accurate test to confirm the diagnosis. […] The diagnostic approach for suspected PUD includes screening for common etiologies on history, e.g., NSAID use. […] Patients 60 years of age without red flags for dyspepsia should begin with noninvasive testing for H. pylori infection. […] Patients with red flags for dyspepsia should be referred directly for EGD (or other indicated diagnostic study).

• #3 Peptic Ulcer Disease | AAFP

  https://www.aafp.org/pubs/afp/issues/2007/1001/p1005.html

  A history of episodic or epigastric pain, relief of pain after food intake, and nighttime awakening because of pain with relief following food intake are the most specific findings for peptic ulcer and help rule in the diagnosis. […] Patients older than 55 years and those with alarm symptoms should be referred for prompt upper endoscopy. […] Esophagogastroduodenoscopy (EGD) is more sensitive and specific for peptic ulcer disease than upper gastrointestinal barium studies and allows biopsy of gastric lesions. […] If test results are positive for H. pylori, the infection should be eradicated and antisecretory therapy, preferably with a proton pump inhibitor, administered for four weeks. […] Further management is based on the endoscopic or radiologic diagnosis.

• #3 Peptic Ulcer Symptoms, Diagnosis, and Treatment | ACE Specialist Clinic

  https://acesurgery.sg/24-7-emergency/acute-peptic-ulcer-complications/

  These can range from minor to potentially fatal. […] A peptic ulcer that bleeds can lead to significant blood loss, resulting in anaemia or even hemorrhagic shock if not promptly treated. […] When a peptic ulcer penetrates through the stomach or duodenal wall, the hole can cause peritonitis, a severe abdominal cavity infection, which is a medical emergency requiring immediate intervention. […] The blockage may cause swelling and inflammation but typically does not require hospitalisation. […] If left untreated, it can result in electrolyte imbalances and dehydration, which can be life-threatening. […] Severe ulcers and their complications can lead to systemic infections, affecting other organs and potentially leading to sepsis, a deadly condition.

• #3 Gastric Ulcer Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/368602-overview

  An upper GI series performed with water-soluble contrast agent may demonstrate the presence and site of the perforation and whether it has sealed. […] CT scanning has no part in the primary detection of gastric ulcers; however, this modality has a role in the detection of subphrenic and other collections that may occur after a perforation of a gastric ulcer. Direct signs of peptic ulcer disease on cross-sectional imaging include focal discontinuity of the mucosal hyperenhancement and identification of luminal outpouching. A useful indirect sign, which alerts to possible active inflammation and/or peptic ulcer, is edematous stranding of the periduodenal fat. […] Multidetector row CT (MDCT) scanning and three-dimensional (3D) imaging are expected to overcome the limitations in cancer staging by offering rapid and accurate information for space perception, detailed hemodynamics, and real-time 3D processing of volumetric data sets.

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