Peptic Ulcer Disease

Peptic ulcer disease is most often linked to H. pylori infection or NSAID exposure. Establish medication exposure, including ongoing NSAID and antiplatelet use, and assess for overt or occult upper gastrointestinal bleeding, vomiting or retained gastric contents suggesting outlet obstruction, and features requiring urgent endoscopic assessment. BMJ+2BMJBritish Society of Gastroenterology and Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland guidance on best practice for upper gastrointestinal endoscopy | Frontline GastroenterologyOxford AcademicAn update on the management of non-variceal upper ...WileyAcid Peptic Disorders

Gastric ulcers deserve particular attention because some endoscopic appearances raise concern for malignancy. Potentially malignant features include a large solitary ulcer, non-antral location, a discolored or necrotic-appearing base, elevated or irregular borders, raised edges with contact bleeding, and disrupted gastric folds. In contrast, nonmalignant ulcers more often are smaller, antral, sharply marginated, and surrounded by normal mucosa. BMJBMJBritish Society of Gastroenterology and Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland guidance on best practice for upper gastrointestinal endoscopy | Frontline Gastroenterology

In gastric ulcer, the cited upper-endoscopy guidance recommends rapid urease testing and biopsies of the ulcer for H. pylori. If both urease testing and histology are negative in a patient receiving a PPI or exposed to antibiotics within the preceding month, obtain a stool antigen test after the procedure once the patient has been off PPI therapy for 2 weeks. BMJBMJBritish Society of Gastroenterology and Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland guidance on best practice for upper gastrointestinal endoscopy | Frontline Gastroenterology

Urea breath testing and stool antigen testing identify active infection. A 2-week washout after PPI or antibiotic use is described for these tests in the supplied primary-care guidance, although its statement groups these agents and does not provide a U.S. specialty-society testing protocol. WHO+1WHOPHC ENG GUIDE 200 - Extranet SystemsWHOLow recovery rate of helicobacter pylori from positive CLO ...

Provide eradication therapy for a positive rapid urease test or stool antigen test. The supplied evidence identifies bismuth-containing quadruple therapy as a commonly used empiric approach internationally, generally for 10 or 14 days, but does not provide enough source-supported drug doses or a U.S. regimen-selection algorithm for this article. BMJ+1BMJBritish Society of Gastroenterology and Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland guidance on best practice for upper gastrointestinal endoscopy | Frontline GastroenterologyBMJBased Helicobacter pylori Infection Control and Management (2021 ...

For an NSAID-associated ulcer, discontinue the NSAID when clinically feasible. A recent JAMA review reports ulcer healing in 95% of cases after stopping the causative NSAID. JAMAJAMAPeptic Ulcer Disease | Gastroenterology

The supplied literature supports PPI treatment in ulcer care and indicates that low-dose aspirin does not appear to delay peptic-ulcer healing when treated with a PPI. The cited evidence involved aspirin 80 to 100 mg daily and should not be extrapolated to higher aspirin doses or other antithrombotic regimens without individualized assessment. BMJBMJAsia-Pacific working group consensus on non-variceal ...

Misoprostol 200 mcg four times daily is reported as approved for prevention of NSAID-induced gastric and duodenal ulcers; diarrhea is a clinically important adverse effect. The supplied excerpt does not provide sufficient current evidence to specify comparative selection, contraindications, or contemporary U.S. dosing recommendations for PPIs, H2-receptor antagonists, or eradication regimens. JAMAJAMAMedical Treatment of Peptic Ulcer Disease

Peptic ulcer disease is described as the most common cause of upper gastrointestinal hemorrhage, ahead of gastritis and esophagitis. Endoscopy is indicated for hemorrhage, and endoscopic hemostatic therapy is identified as the treatment of choice for a high-risk bleeding peptic ulcer. Oxford Academic+2Oxford AcademicAn update on the management of non-variceal upper ...WileyAcid Peptic DisordersWileyEffect of High‐Dose Oral Rabeprazole on Recurrent ...

The supplied evidence does not provide a complete current U.S. pre-endoscopic risk-stratification pathway, transfusion threshold, timing-to-endoscopy standard, endoscopic modality selection, post-endoscopic PPI dose, or rebleeding algorithm. These decisions should therefore be checked against current upper gastrointestinal bleeding guidance and individualized to hemodynamic status, lesion findings, comorbidity, and antithrombotic indication.

Endoscopy is indicated for possible gastric outlet obstruction in the setting of peptic ulcer disease. Distention with retained ingested contents and air may suggest a component of outlet obstruction or gastroparesis, but this finding is not specific for an ulcer-related mechanical obstruction. BMJ+1BMJLarge gastric ulcer presenting as gastric pneumatosisWileyAcid Peptic Disorders

If obstruction is present, distinguish benign ulcer-related narrowing from malignancy, especially when a gastric lesion has irregular, elevated, discolored, non-antral, or otherwise concerning features. The supplied evidence does not provide a contemporary, source-supported U.S. algorithm for dilation, stenting, surgery, or nutritional rescue in ulcer-related obstruction. BMJBMJBritish Society of Gastroenterology and Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland guidance on best practice for upper gastrointestinal endoscopy | Frontline Gastroenterology