Peptic Ulcer Disease Differential Diagnoses

Updated: Oct 03, 2018
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DDx

Diagnostic Considerations

Nonulcer dyspepsia (NUD) or functional dyspepsia

Functional dyspepsia is a diagnosis of exclusion made in patients with chronic persistent epigastric pain in whom a thorough evaluation shows no organic disease. Patients may primarily have epigastric pain, which is referred to as ulcerlike dyspepsia, or they may have symptoms of postprandial bloating, which is referred to as motility-like dyspepsia.

Crohn disease

Crohn ulceration can involve any part of the GI tract from the buccal mucosa to the rectum. Isolated Crohn ulceration of the stomach is rare, although it may cause duodenal or ileal ulcerations.

Zollinger-Ellison syndrome

Zollinger-Ellison syndrome (ZES) is a rare disorder that can cause gastric or duodenal ulcers (usually multiple) from excessive acid secretion. Consider ZES if a patient has severe peptic ulceration, kidney stones, watery diarrhea, or malabsorption. ZES can also be associated with multiple endocrine neoplasia type I, which occurs earlier than isolated ZES. Patients with ZES usually have fasting serum gastrin levels of more than 200 pg/mL and basal gastric acid hypersecretion of more than 15 mEq/h. Proton pump inhibitor (PPI) therapy should be discontinued at least 2 weeks before the gastrin level is measured.

Differential Diagnoses