Peptic Ulcer Disease Questions & Answers

Updated: Aug 01, 2019
  • Author: BS Anand, MD; Chief Editor: Philip O Katz, MD, FACP, FACG  more...
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Questions & Answers

Overview

How are gastric and duodenal ulcers differentiated?

What are the “alarm features” of peptic ulcer disease that necessitate immediate referral to a gastroenterologist?

How is a diagnosis of peptic ulcer disease (PUD) confirmed?

Why is upper GI endoscopy the preferred diagnostic test for peptic ulcer disease (PUD)?

How is peptic ulcer disease (PUD) treated?

How is NSAID-associated peptic ulcer disease (PUD) treated?

When is surgical intervention indicated in in the treatment of peptic ulcer disease (PUD)?

What is the anatomy of the vagal innervation of the abdominal viscera and how does it affect surgical procedures for peptic ulcer disease (PUD)?

What is the pathogenesis of peptic ulcer disease (PUD)?

How do peptic ulcer disease (PUD) occur?

What is the role of H pylori infection (HPI) in peptic ulcer disease (PUD)?

What is the relationship between H pylori gastritis and duodenal ulceration?

What is the etiology of peptic ulcer disease (PUD)?

What is the most common cause of peptic ulcer disease (PUD)?

Which factors increase the risk of NSAID-related peptic ulcer disease (PUD)?

Which factors increase the risk for peptic ulcer disease (PUD) in patients taking low-dose aspirin?

Does the combination of H pylori infection (HPI) and NSAID use increase the risk of developing peptic ulcer disease (PUD)?

What is the prevalence of NSAID gastropathy in children?

Do corticosteroids increase the risk of peptic ulcer disease (PUD)?

Does smoking, alcohol, or caffeine increase the risk of peptic ulcer disease (PUD)?

Which physiologic stress conditions may cause peptic ulcer disease (PUD)?

What are Cushing ulcers?

Which patients are at an increased risk for stress ulceration and upper- GI hemorrhage?

Which hypersecretory states may cause peptic ulcer disease (PUD)?

Which physiologic factors increase the risk of duodenal ulcers?

What is the role of accelerated gastric emptying in peptic ulcer disease (PUD)?

Does cold climate increase the risk of developing peptic ulcer disease (PUD)?

What is the role of genetics in peptic ulcer disease (PUD)?

What are the less common causes of peptic ulcer disease (PUD)?

What is the prevalence of peptic ulcer disease (PUD) in the US?

What is the US incidence of peptic ulcer disease?

Is peptic ulcer disease more common in in males or females?

How is the prevalence of peptic ulcer disease determined outside the US?

How is peptic ulcer disease treated?

What is the incidence of NSAID-related ulcers?

What is the mortality rate for peptic ulcer disease?

Which factors increase the mortality risk associated with emergency surgery for peptic ulcer perforation?

What is the mortality rate for patients undergoing surgery for perforated peptic ulcer?

Which agents are potentially injurious to patients with peptic ulcer disease?

Which counseling may be beneficial for patients with peptic ulcer disease (PUD)?

Presentation

Which history details suggest peptic ulcer disease (PUD)?

How are gastric and duodenal ulcers differentiated?

Which pain characteristics suggest duodenal ulcer?

What are the symptoms of gastric outlet obstruction?

What are the signs and symptoms of peptic ulcer disease (PUD)?

What are the alarm features of peptic ulcer disease (PUD) that necessitate immediate referral to a gastroenterologist?

Which clinical findings suggest uncomplicated peptic ulcer disease (PUD)?

What are the signs and symptoms of perforated peptic ulcer disease (PUD)?

DDX

How is functional dyspepsia diagnosed?

What part of the GI tract is involved in Crohn ulceration?

What is Zollinger-Ellison syndrome (ZES)?

What are the differential diagnoses for Peptic Ulcer Disease?

Workup

What is the role of H pylori testing in the diagnosis of peptic ulcer disease (PUD)?

What are the 2017 ACG guidelines for H pylori testing?

Which lab tests should be performed in suspected peptic ulcer disease (PUD)?

How is the presence of H pylori detected in peptic ulcer disease (PUD)?

Which test finding indicates the presence of H pylori infection?

How do urea breath tests detect H pylori infection?

What is the role of histopathology in the diagnosis of H pylori infection (HPI)?

What is the preferred test for the diagnosis of peptic ulcer disease (PUD)?

What is the appearance of duodenal ulcers on endoscopy?

What is the most common finding in individuals who undergo endoscopy for dyspepsia?

When is a chest X-ray indicated for diagnosis of peptic ulcer disease (PUD)?

When is angiography indicated for suspected peptic ulcer disease (PUD)?

When should screening for Zollinger-Ellison syndrome (ZES) be performed in patients with peptic ulcer disease (PUD)?

When is a secretin simulation test required in in the workup of peptic ulcer disease (PUD)?

How accurate is a biopsy in the diagnosis of gastric cancer?

What is the histology of gastric ulcers?

What testing should be performed in the emergency department (ED) for suspected peptic ulcer disease (PUD)?

Treatment

What are the 2017 ACG guidelines for first-line treatment of H pylori infection (HPI)?

What are the ACG treatment guidelines if first-line therapy for H pylori infection (HPI) fails?

What are the ACG guidelines for salvage treatment regimens in H pylori infection (HPI)?

Which factors determine the treatment of peptic ulcer disease (PUD)?

Which treatment options are available for peptic ulcer disease (PUD)?

What is the role of endoscopy in the management of peptic ulcer disease (PUD)?

Can peptic ulcer disease (PUD) be cured?

What factors determine if endoscopy should be performed in the treatment of peptic ulcer disease (PUD)?

What are the indications for urgent surgery in peptic ulcer disease (PUD)?

How are bleeding peptic ulcers treated?

What are the high-risk stigmata in bleeding peptic ulcer?

Which endoscopic therapy modalities are available for treating peptic ulcer disease (PUD)?

What is the role of hemoclips in the treatment of peptic ulcer disease (PUD)?

What is the role of EGD in the treatment of peptic ulcer disease (PUD)?

Which risk factors predict rebleeding following endoscopic hemostatic therapy (EHT) in peptic ulcer disease (PUD)?

What is the role of acid suppression in the treatment of peptic ulcer disease (PUD)?

Which classes of acid-suppressing medications are currently used in the treatment of peptic ulcer disease (PUD)?

What is the role of PPIs in the treatment of peptic ulcer disease (PUD)?

Is a high-dose PPI regimen more effective than a standard-dose regimen in the treatment of peptic ulcer disease (PUD)?

Does parenteral PPI therapy decrease rebleeding in peptic ulcer disease (PUD)?

What is the overall efficacy of parenteral PPI therapy in peptic ulcer disease (PUD)?

What are the ACG guidelines for the primary treatment of H pylori infection (HPI)?

Who should be considered for testing of H pylori infection (HPI)?

What is PPI -based triple therapy for H pylori infection (HPI)?

What is the typical 14-day PPI-based triple therapy regimen for H pylori infection (HPI)?

Which alternative triple therapy regimens are available for H pylori infection (HPI)?

When should quadruple therapy for H pylori infection (HPI) be considered and what is the typical regimen?

What are the ACG guidelines for prevention of NSAID-related ulcer complications?

How is peptic ulcer disease (PUD) managed when NSAID therapy cannot be discontinued?

How are active NSAID-related ulcers treated?

What are the 2009 ACG treatment guidelines for peptic ulcer disease (PUD) in patients who require NSAID and low-dose aspirin therapy?

How are NSAID-related ulcers prevented?

Which patients should be considered for prophylactic therapy for peptic ulcer disease (PUD)?

What prophylactic regimen is effective in reducing the risk of NSAID-related ulcers?

Is aspirin plus esomeprazole (Nexium) effective in preventing recurrent gastric ulcer bleeding?

Is treatment with combined esomeprazole (Nexium) and clopidogrel (Plavix) effective in reducing recurrence of peptic ulcers?

What are the treatment goals for peptic ulcer disease (PUD) in the emergency department (ED)?

How is high-risk determined in peptic ulcer disease (PUD)?

What drug treatments are available for symptomatic treatment of peptic ulcer disease (PUD)?

How are massive gastric bleeds managed in patients with peptic ulcer disease (PUD)?

When is surgical management of peptic ulcer disease (PUD) indicated?

What are the surgical options for the management of peptic ulcer disease (PUD)?

When is laparoscopic surgery for perforated ulcer contraindicated?

What are the potential complications after surgical treatment of a perforated peptic ulcer?

What are the dietary restrictions for patients with peptic ulcer disease (PUD)?

What are potential complications of peptic ulcer disease (PUD)?

What are the potential health risks of gastric ulcers?

What test should be performed in a patient with persistent nonhealing gastric ulcer?

When is surgical consultation needed in the treatment of peptic ulcer disease (PUD)?

Which maintenance therapy is indicated in high-risk patients with peptic ulcer disease (PUD)?

Which maintenance therapies are effective for recurrent, refractory, or complicated ulcers?

How common is peptic ulcer rebleeding after H pylori eradication?

Medications

What are the goals of pharmacotherapy for peptic ulcer disease (PUD)?

What is the treatment for H pylori infection (HPI)?

Can NSAID-induced ulcers be prevented?

Which medications in the drug class Proton Pump Inhibitors are used in the treatment of Peptic Ulcer Disease?

Which medications in the drug class H2 Receptor Blockers are used in the treatment of Peptic Ulcer Disease?

Which medications in the drug class Antimicrobials are used in the treatment of Peptic Ulcer Disease?

Which medications in the drug class Antidiarrheal Agents are used in the treatment of Peptic Ulcer Disease?

Which medications in the drug class Cytoprotective Agents are used in the treatment of Peptic Ulcer Disease?