Peptic ulcer disease: Difference between revisions
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== | {{subpages}} | ||
==Pathophysiology== | |||
Most peptic ulcers are in the duodenum.<ref name="pmid1202611">{{cite journal |author=Möllmann KM, Bonnevie O, Gudbrand Höyer E, Wulff HR |title=A diagnostic study of patients with upper abdominal pain |journal=Scand. J. Gastroenterol. |volume=10 |issue=8 |pages=805–9 |year=1975 |pmid=1202611 |doi=}}</ref> | |||
==Diagnosis== | |||
==History and physical examination== | |||
One study found that the best predictions of abnormal investigations were: history of an ulcer, age 50 or more, pain better with food or milk, pain occurs < one hour after eating. <ref name="pmid7352814">{{cite journal |author=Marton KI, Sox HC, Wasson J, Duisenberg CE |title=The clinical value of the upper gastrointestinal tract roentgenogram series |journal=Arch. Intern. Med. |volume=140 |issue=2 |pages=191–5 |year=1980 |pmid=7352814 |doi=}}</ref> | |||
If the ulcer is in the duodenum, the pain may be relieved by eating; whereas eating may exacerbate the pain of a gastric ulcer.<ref name="pmid9829354">{{cite journal |author=Carlsson R, Dent J, Bolling-Sternevald E, ''et al'' |title=The usefulness of a structured questionnaire in the assessment of symptomatic gastroesophageal reflux disease |journal=Scand. J. Gastroenterol. |volume=33 |issue=10 |pages=1023–9 |year=1998 |pmid=9829354 |doi=}}</ref><ref name="pmid1265440">{{cite journal |author=Möllmann KM, Bonnevie O, Gudmand-Höyer E, Wulff HR |title=Nosography of X-ray negative dyspepsia |journal=Scand. J. Gastroenterol. |volume=11 |issue=2 |pages=193–7 |year=1976 |pmid=1265440 |doi=}}</ref><ref name="pmid1202611">{{cite journal |author=Möllmann KM, Bonnevie O, Gudbrand Höyer E, Wulff HR |title=A diagnostic study of patients with upper abdominal pain |journal=Scand. J. Gastroenterol. |volume=10 |issue=8 |pages=805–9 |year=1975 |pmid=1202611 |doi=}}</ref><ref name="pmid7352814">{{cite journal |author=Marton KI, Sox HC, Wasson J, Duisenberg CE |title=The clinical value of the upper gastrointestinal tract roentgenogram series |journal=Arch. Intern. Med. |volume=140 |issue=2 |pages=191–5 |year=1980 |pmid=7352814 |doi=}}</ref> As most ulcers are duodenal, in general eating relieves ulcer pain. | |||
Some patients may have chest symptoms such as heartburn or reflux.<ref name="pmid8224642">{{cite journal |author=Talley NJ, Weaver AL, Tesmer DL, Zinsmeister AR |title=Lack of discriminant value of dyspepsia subgroups in patients referred for upper endoscopy |journal=Gastroenterology |volume=105 |issue=5 |pages=1378–86 |year=1993 |pmid=8224642 |doi=}}</ref><ref name="pmid2021764">{{cite journal |author=Johnsen R, Bernersen B, Straume B, Førde OH, Bostad L, Burhol PG |title=Prevalences of endoscopic and histological findings in subjects with and without dyspepsia |journal=BMJ |volume=302 |issue=6779 |pages=749–52 |year=1991 |pmid=2021764 |doi=}} [http://www.pubmedcentral.nih.gov/articlerender.fcgi?pubmedid=2021764 Fulltext]</ref> | Some patients may have chest symptoms such as heartburn or reflux.<ref name="pmid8224642">{{cite journal |author=Talley NJ, Weaver AL, Tesmer DL, Zinsmeister AR |title=Lack of discriminant value of dyspepsia subgroups in patients referred for upper endoscopy |journal=Gastroenterology |volume=105 |issue=5 |pages=1378–86 |year=1993 |pmid=8224642 |doi=}}</ref><ref name="pmid2021764">{{cite journal |author=Johnsen R, Bernersen B, Straume B, Førde OH, Bostad L, Burhol PG |title=Prevalences of endoscopic and histological findings in subjects with and without dyspepsia |journal=BMJ |volume=302 |issue=6779 |pages=749–52 |year=1991 |pmid=2021764 |doi=}} [http://www.pubmedcentral.nih.gov/articlerender.fcgi?pubmedid=2021764 Fulltext]</ref> | ||
== | On physical examination, pallor of conjunctiva, nail-bed or palmar crease, or the absence of nail-bed blanching are predictive of significant anemia (hemoglobin less than 12 gm/dl).<ref name="pmid2297289">{{cite journal |author=Nardone DA, Roth KM, Mazur DJ, McAfee JH |title=Usefulness of physical examination in detecting the presence or absence of anemia |journal=Arch. Intern. Med. |volume=150 |issue=1 |pages=201–4 |year=1990 |pmid=2297289 |doi=}}</ref> | ||
The | |||
===Laboratory testing=== | |||
The accuracy of the ''[[H. pylori]]'' breath test for detecting [[peptic ulcer disease]] is:<ref name="pmid9135516">{{cite journal |author=McColl KE, el-Nujumi A, Murray L, ''et al'' |title=The Helicobacter pylori breath test: a surrogate marker for peptic ulcer disease in dyspeptic patients |journal=Gut |volume=40 |issue=3 |pages=302–6 |year=1997 |pmid=9135516 |doi=}}</ref> | |||
* [[sensitivity (tests)|sensitivity]] 93% | |||
* [[specificity (tests)|specificity]] 60% | |||
==Prevention== | |||
===Users of nonsteroidal anti-inflammatory (NSAID) medications=== | |||
Patients with a history of bleeding ulcer have a 26% rate of ulcers with NSAIDs.<ref name="pmid12755551">{{cite journal |author=Spiegel BM, Targownik L, Dulai GS, Gralnek IM |title=The cost-effectiveness of cyclooxygenase-2 selective inhibitors in the management of chronic arthritis |journal=Ann. Intern. Med. |volume=138 |issue=10 |pages=795–806 |year=2003 |pmid=12755551 |doi=|url=http://www.annals.org/cgi/content/full/138/10/795}}</ref> Patients with [[H. pylori]] have 2.5 risk of an ulcer on NSAIDs.<ref name="pmid11809181">{{cite journal |author=Huang JQ, Sridhar S, Hunt RH |title=Role of Helicobacter pylori infection and non-steroidal anti-inflammatory drugs in peptic-ulcer disease: a meta-analysis |journal=Lancet |volume=359 |issue=9300 |pages=14–22 |year=2002 |pmid=11809181 |doi=}}</ref> | |||
For patients starting long-term NSAIDs, screening for [[H. pylori]] with a breath test among patients with prior ulcer or dyspepsia and treating positive patients reduced subsequent rate of ulcers.<ref name="pmid11809180">{{cite journal |author=Chan FK, To KF, Wu JC, ''et al'' |title=Eradication of Helicobacter pylori and risk of peptic ulcers in patients starting long-term treatment with non-steroidal anti-inflammatory drugs: a randomised trial |journal=Lancet |volume=359 |issue=9300 |pages=9–13 |year=2002 |pmid=11809180 |doi=}}</ref> <ref name="pmid9329511">{{cite journal |author=Chan FK, Sung JJ, Chung SC, ''et al'' |title=Randomised trial of eradication of Helicobacter pylori before non-steroidal anti-inflammatory drug therapy to prevent peptic ulcers |journal=Lancet |volume=350 |issue=9083 |pages=975–9 |year=1997 |pmid=9329511 |doi=}}</ref> | |||
For patients who must take NSAIDs, proton pump inhibitors may be effective in preventing dyspepsia.<ref name="pmid16651060">{{cite journal |author=Spiegel BM, Farid M, Dulai GS, Gralnek IM, Kanwal F |title=Comparing rates of dyspepsia with Coxibs vs NSAID+PPI: a meta-analysis |journal=Am. J. Med. |volume=119 |issue=5 |pages=448.e27–36 |year=2006 |pmid=16651060 |doi=10.1016/j.amjmed.2005.11.020}}</ref> | |||
==References== | ==References== | ||
{{reflist|2}}[[Category:Suggestion Bot Tag]] | |||
[[Category: | |||
Latest revision as of 16:00, 2 October 2024
Pathophysiology
Most peptic ulcers are in the duodenum.[1]
Diagnosis
History and physical examination
One study found that the best predictions of abnormal investigations were: history of an ulcer, age 50 or more, pain better with food or milk, pain occurs < one hour after eating. [2]
If the ulcer is in the duodenum, the pain may be relieved by eating; whereas eating may exacerbate the pain of a gastric ulcer.[3][4][1][2] As most ulcers are duodenal, in general eating relieves ulcer pain.
Some patients may have chest symptoms such as heartburn or reflux.[5][6]
On physical examination, pallor of conjunctiva, nail-bed or palmar crease, or the absence of nail-bed blanching are predictive of significant anemia (hemoglobin less than 12 gm/dl).[7]
Laboratory testing
The accuracy of the H. pylori breath test for detecting peptic ulcer disease is:[8]
- sensitivity 93%
- specificity 60%
Prevention
Users of nonsteroidal anti-inflammatory (NSAID) medications
Patients with a history of bleeding ulcer have a 26% rate of ulcers with NSAIDs.[9] Patients with H. pylori have 2.5 risk of an ulcer on NSAIDs.[10]
For patients starting long-term NSAIDs, screening for H. pylori with a breath test among patients with prior ulcer or dyspepsia and treating positive patients reduced subsequent rate of ulcers.[11] [12]
For patients who must take NSAIDs, proton pump inhibitors may be effective in preventing dyspepsia.[13]
References
- ↑ 1.0 1.1 Möllmann KM, Bonnevie O, Gudbrand Höyer E, Wulff HR (1975). "A diagnostic study of patients with upper abdominal pain". Scand. J. Gastroenterol. 10 (8): 805–9. PMID 1202611. [e]
- ↑ 2.0 2.1 Marton KI, Sox HC, Wasson J, Duisenberg CE (1980). "The clinical value of the upper gastrointestinal tract roentgenogram series". Arch. Intern. Med. 140 (2): 191–5. PMID 7352814. [e]
- ↑ Carlsson R, Dent J, Bolling-Sternevald E, et al (1998). "The usefulness of a structured questionnaire in the assessment of symptomatic gastroesophageal reflux disease". Scand. J. Gastroenterol. 33 (10): 1023–9. PMID 9829354. [e]
- ↑ Möllmann KM, Bonnevie O, Gudmand-Höyer E, Wulff HR (1976). "Nosography of X-ray negative dyspepsia". Scand. J. Gastroenterol. 11 (2): 193–7. PMID 1265440. [e]
- ↑ Talley NJ, Weaver AL, Tesmer DL, Zinsmeister AR (1993). "Lack of discriminant value of dyspepsia subgroups in patients referred for upper endoscopy". Gastroenterology 105 (5): 1378–86. PMID 8224642. [e]
- ↑ Johnsen R, Bernersen B, Straume B, Førde OH, Bostad L, Burhol PG (1991). "Prevalences of endoscopic and histological findings in subjects with and without dyspepsia". BMJ 302 (6779): 749–52. PMID 2021764. [e] Fulltext
- ↑ Nardone DA, Roth KM, Mazur DJ, McAfee JH (1990). "Usefulness of physical examination in detecting the presence or absence of anemia". Arch. Intern. Med. 150 (1): 201–4. PMID 2297289. [e]
- ↑ McColl KE, el-Nujumi A, Murray L, et al (1997). "The Helicobacter pylori breath test: a surrogate marker for peptic ulcer disease in dyspeptic patients". Gut 40 (3): 302–6. PMID 9135516. [e]
- ↑ Spiegel BM, Targownik L, Dulai GS, Gralnek IM (2003). "The cost-effectiveness of cyclooxygenase-2 selective inhibitors in the management of chronic arthritis". Ann. Intern. Med. 138 (10): 795–806. PMID 12755551. [e]
- ↑ Huang JQ, Sridhar S, Hunt RH (2002). "Role of Helicobacter pylori infection and non-steroidal anti-inflammatory drugs in peptic-ulcer disease: a meta-analysis". Lancet 359 (9300): 14–22. PMID 11809181. [e]
- ↑ Chan FK, To KF, Wu JC, et al (2002). "Eradication of Helicobacter pylori and risk of peptic ulcers in patients starting long-term treatment with non-steroidal anti-inflammatory drugs: a randomised trial". Lancet 359 (9300): 9–13. PMID 11809180. [e]
- ↑ Chan FK, Sung JJ, Chung SC, et al (1997). "Randomised trial of eradication of Helicobacter pylori before non-steroidal anti-inflammatory drug therapy to prevent peptic ulcers". Lancet 350 (9083): 975–9. PMID 9329511. [e]
- ↑ Spiegel BM, Farid M, Dulai GS, Gralnek IM, Kanwal F (2006). "Comparing rates of dyspepsia with Coxibs vs NSAID+PPI: a meta-analysis". Am. J. Med. 119 (5): 448.e27–36. DOI:10.1016/j.amjmed.2005.11.020. PMID 16651060. Research Blogging.