Treatment: Early institution of PPI prophylaxis with oral or intravenous pantoprazole (Protonix) minimizes ulcer risk histamine H 2 blockers and sucralfate (Carafate) are other options for prophylaxis Presentation: Patients may be asymptomatic or may develop bleeding or perforation Presentation: More likely to have painless ulcers 50 percent present acutely (e.g., with perforation) may present with nonspecific complaints (e.g., confusion, restlessness, abdominal distention, fall)Ĭomplications: Perforations associated with mortality three times higher than in younger patients hemorrhagic complications more likely (20 percent from silent ulcers) more likely to have continued bleeding and to need transfusions and surgeryĬause: Breakdown of mucosal protectants as a result of stress leads to splanchnic hypoperfusion and ulcer risk factors include mechanical ventilation longer than 48 hours, burns, coagulopathy, moderate to severe trauma, head or spinal cord injury, liver failure, and organ transplantation pylori testing and treatment recommended only if ulcer is documented by EGD or contrast studiesĬomplications: 25 percent of bleeding duodenal ulcers may be silent perforation and penetration rare ![]() Testing: EGD should be performed if ulcer suspected test- and-treat strategy not recommended H. Presentation: Patients may present with poorly localized abdominal pain Incidence: Rare most ulcers occur between eight and 17 years of age duodenal ulcer up to 30 times more common than gastric ulcerĬause: Helicobacter pylori infection contributory pylori infection should be eradicated to minimize the need for long-term antisecretory therapy and further surgical intervention. In patients with perforated ulcers, coexisting H. pylori testing should be performed and eradication therapy prescribed if results are positive. Patients with bleeding peptic ulcers should be given a proton pump inhibitor to reduce transfusion requirements, need for surgery, and duration of hospitalization. ![]() In patients with peptic ulcers, proton pump inhibitors provide acid suppression, healing rates, and symptom relief superior to other antisecretory therapies. In patients with peptic ulcer disease, Helicobacter pylori should be eradicated to assist in healing and to reduce the risk of gastric and duodenal ulcer recurrence. Prompt upper endoscopy is recommended for patients with peptic ulcers who are older than 55 years, those who have alarm symptoms, and those with ulcers that do not respond to treatment. Peritonitis is a surgical emergency requiring patient resuscitation laparotomy and peritoneal toilet omental patch placement and, in selected patients, surgery for ulcer control. Perforation and gastric outlet obstruction are rare but serious complications. Administration of proton pump inhibitors and endoscopic therapy control most bleeds. Bleeding is the most common indication for surgery. Surgery is indicated if complications develop or if the ulcer is unresponsive to medications. Patients with persistent symptoms should be referred for endoscopy. pylori infection is diagnosed, the infection should be eradicated and antisecretory therapy (preferably with a proton pump inhibitor) given for four weeks. For younger patients with no alarm symptoms, a test-and-treat strategy based on the results of H. ![]() Patients taking nonsteroidal anti-inflammatory drugs should discontinue their use. ![]() Older patients and patients with alarm symptoms indicating a complication or malignancy should have prompt endoscopy. Symptoms of peptic ulcer disease include epigastric discomfort (specifically, pain relieved by food intake or antacids and pain that causes awakening at night or that occurs between meals), loss of appetite, and weight loss. The predominant causes in the United States are infection with Helicobacter pylori and use of nonsteroidal anti-inflammatory drugs. Peptic ulcer disease usually occurs in the stomach and proximal duodenum.
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