Peptic ulcer disease: Difference between revisions
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== | ==Pathophysiology== | ||
The pain may be relieved by eating.<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> | 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="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 accuracy of 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% | * [[sensitivity (tests)|sensitivity]] 93% | ||
* [[specificity (tests)|specificity]] 60% | * [[specificity (tests)|specificity]] 60% | ||
Revision as of 01:32, 12 October 2007
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][1][2] As most ulcers are duodenal, in general eating relieves ulcer pain.
Some patients may have chest symptoms such as heartburn or reflux.[4][5]
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).[6]
Laboratory testing
The accuracy of the H. pylori breath test for detecting peptic ulcer disease is:[7]
- sensitivity 93%
- specificity 60%
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]
- ↑ 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]