PEPTIC ULCER DISEASE DIFFERENTIAL DIAGNOSIS

Differential Dx Rule In Rule Out Diagnostics

Chrohn’s disease  Abdominal pain  Diarrhea Barium study:
 Weight loss  fever  Earliest radiographic findings
 Hematochezia  anorexia include thickened and
 smoking  dysuria aphthous ulceration.
Endoscopic Findings:
 Rectal sparing is specific
 Aphthous ulceration, edema,
cobblestoning may be
present.

Mallory-Weiss  Intermittent  Risk factors such as  Endoscopy to identify the

Tear epigastric pain blunt abdominal location of lesion and to
 Hematochezia trauma, straining, identify presence of active
 fatigue retching, hiatal bleeding or a fibrin crust over
 Weight loss hernia. a mucosal split within or near
 Alcoholic  Tachycardia the gastroesophageal junction.
drinker  Hypotension  Hematologic examination
 Not relieved when should be done to assess
eating or intake of severe thrombocytopenia.
food.

Gastroesophageal  Intermittent  Heartburn  Endoscopy is standard for

reflux disease epigastric pain  chest pain documenting presence and
(GERD)  Smoking  cough severity of esophagitis.
 Drinking coffee  laryngitis  Endoscopic findings in
 Alcohol  Disrupted sleep GERD: edema, erythema,
consumption  Regurgitation of food friability, read streaks,
 NSAID use or sour liquid erosions, ulcers.

PEPTIC ULCER DISEASE DIAGNOSTICS

DIAGNOSTICS REMARKS
Rapid urase test  Is a rapid diagnostic test for diagnosis of
Helicobacter pylori. Basis of the test is the
ability of H. pylori to secrete
the urease enzyme, which catalyzes the
conversion of urea to ammonia and carbon
dioxide.
Histology  Provides histologic information and require
pathology processing.
Culture  Allows determination of antibiotic
susceptibility.
Urea breath test  A rapid diagnostic procedure used to identify
infections by Helicobacter pylori, a spiral
bacterium implicated in gastritis, gastric
ulcer, and peptic ulcer disease.
 Stool Antigen  Looks for foreign proteins (antigens)
associated with H. pylori infection in your
stool. As with the breath test, PPIs and
bismuth subsalicylate can affect the results of
this test, so advise to hold medication.
Barium studies of Proximal GIT  Use as first test for documenting an ulcer.
GU: discrete crater with radiating mucosal
folds originating from the ulcer margin,
commonly located in the antrum.
DU: appears as a well demarcated crater,
most ofte seen in the bulb.
Endoscopy  Provides most sensitive and specific
approach for examining the upper GI tract.
 It permits direct visualization of the mucosa
and facilitates photographic documentation
of mucosal defect such as ulcers to determine
the source of blood loss and tissue biopsy to
rule out malignancy.

TREATMENT ND MANAGEMET OF PEPTIC ULCER DISEASE

Medication Example and dose Rationale

Antacid  Aluminum Hydroxide 5-30  Neutralizes gastric acidity.
mL between meals and HS

 Magnesium Hydroxide 400

H2 Receptor Agonist
Proton Pump Inhibitor
mg PO q4
 Cimetidine 400 mg BID  Competitive inhibition at
 Ranitidine 300 mg HS the parietal cell H2 receptor
 Famotidine 40mg HS and suppresses acid
 Nizatidine 300 mg HS secretion.
 Omeprazole 20 mg/d  Covalently bind and
 Lansoprazole 30 mg/d irreversibly inhibit H, K-
 Rabeprazole 20 mg/d ATPase.
 Pantoprazole 40 mg/d  Most potent acid inhibitory
 Esomeprazole 20 mg/d agents
 Dexiansoprazole 30
mg/day

PREVENTION:
1. It may not be possible to prevent a peptic ulcer. However, reducing risk, such as quitting
tobacco use and eating a healthful diet may help.
2. People who use NSAIDs or other medications that can cause peptic ulcers should talk to a
doctor about managing ulcer-related risk. A doctor may recommend taking:
 Medications with meals
 Lower dosages
 Alternate medications
 Acid-reducing drugs
3. To prevent H. pylori spreads people should protect themselves by cooking foods thoroughly
and frequently washing the hands with soap and water.