Peptic ulcer disease

Background

• Recurrent ulcerations in the stomach and proximal duodenum
• Majority of cases related to H. pylori or NSAID use
  • H. pylori found in 30-40% of U.S. population
  • NSAIDs inhibit prostaglandin synthesis (decreases mucus and bicarb production)

Diagnosis

• Burning epigastric pain
  • May awaken pt at night (gastric contents empty)
• Abrupt onset of severe pain may indicate perforation
• Abrupt onset of back pain may indicate penetration into the pancreas
• The following symptoms are NOT associated w/ PUD:
  • Postprandial pain, food intolerance, nausea, retrosternal pain, belching

Red Flags

1. Age >55yr
2. Unexplained weight loss
3. Early satiety
4. Persistent vomiting
5. Dysphagia
6. Anemia or GI bleeding
7. Abdominal mass
8. Persistent anorexia
9. Jaundice

DDx

Abdominal_Pain#Epigastric