Overview
How are gastric and duodenal ulcers differentiated?
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 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?
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)?
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?
What is the international prevalence of peptic ulcer disease?
How is peptic ulcer disease treated?
What is the incidence of NSAID-related ulcers?
What is the mortality rate for peptic ulcer disease?
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)?
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)?
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 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?
Treatment
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 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)?
What is the role of acid suppression in the treatment of peptic ulcer disease (PUD)?
What is the role of PPIs 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 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?
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?
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?
Guidelines
What are the WSES guidelines for the diagnosis and treatment of bleeding peptic ulcers?
What are the WSES guidelines for the diagnosis and treatment of perforated peptic ulcer?
What are the ASGE guidelines for sedation and anesthesia in gastrointestinal endoscopy?
What are the ACG recommendations for testing for H pylori?
What are the ACG guidelines for the treatment of H pylori infection (HPI)?
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?
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Peptic ulcer disease. Vagal innervation of the stomach.
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Peptic ulcer disease. Gastric ulcer with a punched-out ulcer base and whitish fibrinoid exudates.
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Peptic ulcer disease. Gastric ulcer (lesser curvature) with a punched-out ulcer base with a whitish exudate.
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Peptic ulcer disease. Gastric cancer. Note the irregular heaped-up overhanging margins.
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Peptic ulcer disease. Gastric cancer with an ulcerated mass.
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Peptic ulcer disease. Gross pathology specimen of a gastric ulcer.
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Peptic ulcer disease. Gastric cancer with an ulcerated mass.
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Peptic ulcer disease. Endoscopic view of an ulcer (at the upper center) in the wall of the duodenum, the first part of the small intestine. This ulcer is an open sore. Image courtesy of Science Source | Gastrolab.
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Peptic ulcer disease. Duodenal ulcer in a 65-year-old man with osteoarthritis who presented with hematemesis and melena. The patient took naproxen on a daily basis.