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Last Updated: 9/23/2014  

Peptic Ulcer Disease

Prevention
  • Administer misoprostol or PPIs to reduce the risk for ulcers and ulcer complications for patients at increased risk who regularly use NSAIDs.

Diagnosis
  • Symptoms and physical exam findings have poor positive or negative predictive value for H. pylori or NSAID-associated peptic ulcer disease.

  • Upper endoscopy is the test of choice for diagnosing peptic ulcer disease.

  • Gastric biopsy to diagnose Helicobacter pylori should be performed whenever upper GI endoscopy is done in the presence of gastric or duodenal ulcers and tested with the urease test.

  • Test for H. pylori in patients with duodenal or gastric ulcers, gastric MALT lymphoma, previous resection of early gastric cancer, and patients younger than age 55 with uninvestigated dyspepsia and no alarm symptoms.

  • Use an antibody test, urea breath test, or stool antigen test in ulcer patients not undergoing endoscopy.

Therapy
  • Use therapy directed at eliminating H. pylori as the treatment of choice for gastric or duodenal ulcers and for preventing recurrences.

  • If the test result for H. pylori is negative, begin acid-suppressive therapy for ulcer healing in the presence of a documented gastric or duodenal ulcer, and consider unusual causes of ulcer.

  • Obtain urgent upper endoscopy for patients with a bleeding gastric or duodenal ulcer.

Follow-up
  • For patients treated for H. pylori, use a noninvasive test (urea breath test or stool antigen test) to document eradication of H. pylori.

  • Patients with uncomplicated H. pylori-negative duodenal ulcers do not need further follow-up if symptoms have resolved.

DOI: 10.7326/d181
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Disclosures:
Michael Koss, MD University of Illinois at Chicago
Chicago, IL
has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Jay Goldstein, MD University of Illinois at Chicago
Chicago, IL
is a consultant for Pfizer, AstraZeneca, TAP, Pozen, Novartis; received honorarium from Pfizer, AstraZeneca, TAP, Pozen, Novartis; received grants from Pfizer, AstraZeneca, TAP, Pozen, Novartis, SmithKlineGlaxo, Takeda, Sucampo.
David Y. Graham, MD, MACG is an unpaid consultant for Novartis in relation to vaccine development for treatment or prevention of H. pylori infection; is a paid consultant for RedHill Biopharma regarding novel H. pylori therapies and has received research support for culture of H. pylori; and is a consultant for Otsuka Pharmaceuticals regarding diagnostic testing. David Y. Graham, MD, MACG is an unpaid consultant for Novartis in relation to vaccine development for treatment or prevention of H. pylori infection; is a paid consultant for RedHill Biopharma regarding novel H. pylori therapies and has received research support for culture of H. pylori; and is a consultant for Otsuka Pharmaceuticals regarding diagnostic testing.
The following editors of ACP Smart Medicine have nothing to disclose: Deborah Korenstein, MD, FACP, Editor in Chief; Richard B. Lynn, MD, FACP, Editor; and Davoren Chick, MD, Editor.
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