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Peptic ulcer disease
Other Resources UpToDate PubMed

Peptic ulcer disease

Contributors: Michael W. Winter MD, Christine Osborne MD, Desiree Rivera-Nieves MD, Khaled Bittar MD, Nishant H. Patel MD
Other Resources UpToDate PubMed


Peptic ulcer disease refers to the formation of ulcers in the gastric or duodenal mucosa. It is most commonly caused by excessive NSAID use or Helicobacter pylori infection. The incidence of peptic ulcers that are H pylori positive has been decreasing over the past few decades. Both gastric and duodenal ulcers are characterized by a burning epigastric pain. Gastric ulcer pain typically worsens with food intake; pain from duodenal ulcers is often alleviated with food intake. Prolonged steroid use, excessive alcohol consumption, prolonged intubation, and Zollinger-Ellison syndrome can predispose to ulcer formation as well. It may be difficult to identify the cause of the ulcers.

The primary complications of peptic ulcers are acute bleeding with blood loss anemia and perforation due to ulcer erosion through the mucosal wall. These complications require either endoscopic or surgical intervention.


K27.9 – Peptic ulcer, site unspecified, unspecified as acute or chronic, without hemorrhage or perforation

13200003 – Peptic ulcer

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Gastritis
  • Acute coronary syndrome
  • Coronary artery disease
  • Esophagitis
  • Esophageal spasm (see Esophageal motility disorder)
  • Gastroparesis
  • Hiatal hernia
  • Gastroenteritis
  • Chronic mesenteric ischemia
  • Inflammatory bowel disease (Ulcerative colitis, Crohn disease)
  • Malignancy (particularly Esophageal carcinoma, Gastric cancer, small bowel, and Pancreatic carcinoma)
  • Biliary colic / Biliary calculus
  • Zollinger-Ellison syndrome
  • Celiac disease
  • Tropical sprue
  • Chronic pancreatitis
  • Drug side effects (NSAIDs, alcohol, caffeine, antibiotics, corticosteroids, opiates, digoxin)
  • Irritable bowel syndrome

Best Tests

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Management Pearls

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Reviewed:09/25/2017
Last Updated:07/06/2021
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Patient Information for Peptic ulcer disease
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Peptic ulcer disease
A medical illustration showing key findings of Peptic ulcer disease : Nausea, Vomiting, Epigastric pain, Heme+ stool, Dyspepsia, RBC decreased
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