Peptic ulcer disease
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%
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]