case study peptic ulcer disease quizlet

Peptic Ulcer Disease

Learn more about the nursing care management of patients with peptic ulcer disease in this study guide .

Table of Contents

• What is Peptic Ulcer Disease? 

Classification

Pathophysiology, statistics and epidemiology, clinical manifestations, complications, assessment and diagnostic findings, medical management, surgical management, nursing assessment, nursing diagnosis, nursing care planning & goals, nursing interventions, discharge and home care guidelines, documentation guidelines, what is peptic ulcer disease.

A peptic ulcer may be referred to as a gastric, duodenal, or esophageal ulcer, depending on its location.

• A peptic ulcer is an excavation that forms in the mucosal wall of the stomach , in the pylorus, in the duodenum, or in the esophagus .
• The erosion of a circumscribed area may extend as deep as the muscle layers or through the muscle to the peritoneum.

Peptic ulcer is classified into gastric, duodenal or esophageal ulcer.

• Gastric ulcer . Gastric ulcer tend to occur in the lesser curvature of the stomach, near the pylorus.
• Duodenal ulcer . Peptic ulcers are more likely to occur in the duodenum than in the stomach.
• Esophageal ulcer . Esophageal ulcer occur as a result pf the backward flow of HCl from the stomach into the esophagus.

Peptic ulcers occur mainly in the gastroduodenal mucosa.

• Erosion. The erosion is caused by the increased concentration or activity of acid-pepsin or by decreased resistance of the mucosa.
• Damage. A damaged mucosa cannot secrete enough mucus to act as a barrier against HCl.
• Acid secretion. Patients with duodenal ulcers secrete more acid than normal, while patients with gastric ulcers tend to secrete normal or decreased levels of acid.
• Decreased resistance. Damage to the gastroduodenal mucosa results in decreased resistance to bacteria and thus infection from the H. pylori bacteria may occur.

Peptic ulcer disease may occur in both genders and in all ages.

• Peptic ulcer disease occurs with the greatest frequency in people between 40 and 60 years of age .
• It is relatively uncommon in women of childbearing age, but it has been observed in children and even in infants.
• After menopause , the incidence of peptic ulcers in women is almost equal to that in men.

There are three major causes of peptic ulcer disease: infection with H. pylori, chronic use of NSAIDs , and pathologic hypersecretory disorders (e.g., Zollinger-Ellison syndrome).

• Helicobacter pylori . Research has documented that peptic ulcers result from infection with the gram-negative bacteria H. pylori, which may be acquired through ingestion of food and water. H. pylori damage the mucous coating that protects the stomach and duodenum.
• Salicylates and NSAIDs. Encourages ulcer formation by inhibiting the secretion of prostaglandins.
• Various illnesses. Pancreatitis , hepatic disease, Crohn’s disease, gastritis, and Zollinger-Ellison syndrome are also known causes.
• Excess HCl. Excessive secretion of HCl in the stomach may contribute to the formation of peptic ulcers.
• Irritants. Ingestion of milk and caffeinated beverages and alcohol also increase HCl secretion. These contribute by accelerating gastric emptying time and promoting mucosal breakdown.
• Blood type.  Gastric ulcers tend to strike people with type A blood while duodenal ulcers tend to afflict people with type O blood.

Symptoms of ulcer may last for a few days, weeks, months, and may disappear only to reappear, often without an identifiable cause.

• Pain . As a rule, the patient with an ulcer complains of dull, gnawing pain or a burning sensation in the midepigastrium or the back that is relieved by eating.
• Pyrosis. Pyrosis (heartburn) is a burning sensation in the stomach and esophagus that moves up to the mouth .
• Vomiting . Vomiting results from obstruction of the pyloric orifice, caused by either muscular spasm of the pylorus or mechanical obstruction from scarring.
• Constipation and diarrhea . Constipation or diarrhea may occur, probably as a result of diet and medications.
• Bleeding . 15% of patients may present with GI bleeding as evidenced by the passage of melena (tarry stools).

Possible complications may include:

• Hemorrhage. Hemorrhage, the most common complication, occurs in 10% to 20% of patients with peptic ulcers in the form of hematemesis or melena.
• Perforation and penetration. Perforation is the erosion of the ulcer through the gastric serosa into the peritoneal cavity without warning, while penetration is the erosion of the ulcer through the gastric serosa into adjacent structures.
• Pyloric obstruction. Pyloric obstruction occurs when the area distal to the pyloric sphincter becomes scarred and stenosed from spasm or edema or from scar tissue that forms when an ulcer alternately heals and breaks down.

To establish the diagnosis of peptic ulcer, the following assessment and laboratory studies should be performed:

• Esophagogastroduodenoscopy. Confirms the presence of an ulcer and allows cytologic studies and biopsy to rule out H. pylori or cancer .
• Physical examination. A physical examination may reveal pain , epigastric tenderness, or abdominal distention.
• Barium study. A barium study of the upper GI tract may show an ulcer.
• Endoscopy. Endoscopy is the preferred diagnostic procedure because it allows direct visualization of inflammatory changes, ulcers, and lesions.
• Occult blood. Stools may be tested periodically until they are negative for occult blood.
• Carbon 13 (13C) urea breath test. Reflects activity of H. pylori.

Once the diagnosis is established, the patient is informed that the condition can be controlled.

• Pharmacologic therapy. Currently, the most commonly used therapy for peptic ulcers is a combination of antibiotics , proton pump inhibitors , and bismuth salts that suppress or eradicate the infection.
• Stress reduction and rest. Reducing environmental stress requires physical and psychological modifications on the patient’s part as well as the aid and cooperation of family members and significant others.
• Smoking cessation. Studies have shown that smoking decreases the secretion of bicarbonate from the pancreas into the duodenum, resulting in increased acidity of the duodenum.
• Dietary modification. Avoiding extremes of the temperature of food and beverages and overstimulation from consumption of meat extracts, alcohol, coffee, and other caffeinated beverages, and diets rich in cream and milk should be implemented.

The introduction of antibiotics to eradicate H. pylori and of H2 receptor antagonists as a treatment for ulcers has greatly reduced the need for surgical interventions.

• Pyloroplasty. Pyloroplasty involves transecting nerves that stimulate the acid secretion and opening the pylorus.
• Antrectomy . Antrectomy is the removal of the pyloric portion of the stomach with anastomosis to either the duodenum or jejunum.

Nursing Management

The management of the patient with a peptic ulcer is as follows:.

Nursing assessment includes:

• Assessment for a description of pain.
• Assessment of relief measures to relieve the pain.
• Assessment of the characteristics of the vomitus.
• Assessment of the patient’s usual food intake and food habits.

Based on the assessment data, the patient’s nursing diagnoses may include the following:

• Acute pain related to the effect of gastric acid secretion on damaged tissue.
• Anxiety related to an acute illness.
• Imbalanced nutrition related to changes in the diet.
• Deficient knowledge about prevention of symptoms and management of the condition.

Main Article: 5 Peptic Ulcer Disease Nursing Care Plans

The goals for the patient may include:

• Relief of pain.
• Reduced anxiety .
• Maintenance of nutritional requirements.
• Knowledge about the management and prevention of ulcer recurrence.
• Absence of complications.

Nursing interventions for the patient may include:

Relieving Pain and Improving Nutrition

• Administer prescribed medications.
• Avoid aspirin , which is an anticoagulant, and foods and beverages that contain acid-enhancing caffeine (colas, tea, coffee, chocolate), along with decaffeinated coffee.
• Encourage patient to eat regularly spaced meals in a relaxed atmosphere; obtain regular weights and encourage dietary modifications.
• Encourage relaxation techniques.

Reducing Anxiety

• Assess what patient wants to know about the disease, and evaluate level of anxiety; encourage patient to express fears openly and without criticism.
• Explain diagnostic tests and administering medications on schedule.
• Interact in a relaxing manner, help in identifying stressors, and explain effective coping techniques and relaxation  methods.
• Encourage family to participate in care, and give emotional support.

Monitoring and Managing Complications

If hemorrhage is a concern:

• Assess for faintness or dizziness and nausea , before or with bleeding; test stool for occult or gross blood; monitor vital signs frequently (tachycardia, hypotension , and tachypnea ).
• Insert an indwelling urinary catheter and monitor intake and output; insert and maintain an IV line for infusing fluid and blood.
• Monitor laboratory values ( hemoglobin and hematocrit).
• Insert and maintain a nasogastric tube and monitor drainage; provide lavage as ordered.
• Monitor oxygen saturation and administering oxygen therapy.
• Place the patient in the recumbent position with the legs elevated to prevent hypotension , or place the patient on the left side to prevent aspiration from vomiting .
• Treat hypovolemic shock as indicated.

If perforation and penetration are concerns:

• Note and report symptoms of penetration (back and epigastric pain not relieved by medications that were effective in the past).
• Note and report symptoms of perforation (sudden abdominal pain, referred pain to shoulders, vomiting and collapse, extremely tender and rigid abdomen, hypotension and tachycardia, or other signs of shock).

Home Management and Teaching Self-Care

• Assist the patient in understanding the condition and factors that help or aggravate it.
• Teach patient about prescribed medications, including name,  dosage , frequency, and possible side effects. Also identify medications such as aspirin that patient should avoid.
• Instruct patient about particular foods that will upset the gastric mucosa, such as coffee, tea, colas, and alcohol, which have acid-producing potential.
• Encourage patient to eat regular meals in a relaxed setting  and to avoid overeating .
• Explain that smoking may interfere with ulcer healing; refer patient to programs to assist with smoking cessation.
• Alert patient to signs and symptoms of complications to be reported. These complications include hemorrhage  (cool skin, confusion , increased heart rate , labored breathing, and blood in the stool), penetration and perforation (severe abdominal pain, rigid and tender abdomen, vomiting , elevated temperature, and increased heart rate ), and pyloric obstruction (nausea, vomiting, distended abdomen, and abdominal pain). To identify obstruction, insert and monitor nasogastric tube ; more than 400 mL residual suggests obstruction.

Expected patient outcomes include:

• Reduced anxiety.
• Maintained nutritional requirements.

The patient should be taught self-care before discharge.

• Factors that affect. The nurse instructs the patient about factors that relieve and those that aggravate the condition.
• Medications. The nurse reviews information about medications to be taken at home, including name, dosage, frequency, and possible side effects, stressing the importance of continuing to take medications even after signs and symptoms have decreased or subsided.
• Diet. The nurse instructs the patient to avoid certain medications and foods that exacerbate symptoms as well as substances that have acid-producing potential.
• Lifestyle. It is important to counsel the patient to eat meals at regular times and in a relaxed setting and to avoid overeating.

The focus of documentation should include:

• Client’s description of response to pain.
• Acceptable level of pain.
• Expectations of pain management .
• Prior medication use.
• Level of anxiety.
• Description of feelings (expressed and displayed).
• Awareness and ability to recognize and express feelings.
• Caloric intake.
• Individual cultural or religious restrictions and personal preferences.
• Learning style, identified needs, presence of learning blocks.
• Plan of care.
• Teaching plan.
• Response to interventions, teaching, and actions performed.
• Attainment or progress toward desired outcomes .
• Modifications to plan of care.
• Long term needs.

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13 thoughts on “Peptic Ulcer Disease”

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These notes are a-mazing! Thank you Marianne! All the best with your nursing career and the little one!

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Hey there Mildred,

You’re very welcome! I’m delighted to hear the information on peptic ulcer disease was helpful, especially with your exams around the corner. Remember, understanding the basics and management strategies is key. Best of luck with your exams – you’ve got this!

If you need any last-minute clarifications or tips, just give a shout.

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Peptic Ulcer Disease Case Study (60 min)

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Mrs. Baker is a 54 year old female who presented to the ED complaining of nausea and severe epigastric pain x 3 days. She reports a history of osteoarthritis and reports taking ibuprofen 400 mg 3-4 times a day regularly for the last few months since her “arthritis has gotten really bad”.

What initial nursing assessments should be performed?

• Put the patient on a monitor to assess EKG. A 12-lead EKG should be done to rule out cardiac involvement, request order for cardiac enzymes from provider
• Auscultate heart and lung sounds
• Full abdominal assessment – inspect, auscultate, palpate and percuss. Assess for tenderness over specific areas, feel for masses, and look for guarding.
• Get more detailed history questions – vomiting? Bloody stools? Has this happened before?

Patient demonstrates guarding when palpating epigastric region, no tenderness to palpation over RLQ, LLQ, or LUQ. Some tenderness over RUQ.  Bowel sounds are hyperactive, lungs are clear to auscultation, S1 and S2 heard clearly with no murmurs. As you finish your assessment, Mrs. Baker reports she is going to be sick and vomits approximately 300 mL of coffee-ground emesis.

Explain the significance of coffee-ground emesis.

• Coffee-ground emesis is vomit that looks like it has coffee-grounds in it.
• These black specs are actually hemolyzed blood cells/clots.
• Coffee-ground emesis is indicative of a slow source of bleeding within the stomach or refluxing from the duodenum.

You notify the provider of the coffee-ground emesis, administer Ondansetron 4 mg IV per provider orders, and assist Mrs. Baker with oral care.

What further diagnostic testing do you expect to be performed for this patient?

• Complete Blood Count
• Occult blood testing of stool and emesis
• Patient may need an EGD (esophagogastroduodenoscopy) to check for bleeding ulcers

Mrs. Baker is now weak and drowsy. Her fecal occult test is positive and her CBC shows a Hemoglobin of 10 g/dL and a Hematocrit of 31%.  Per provider orders, you insert an NG tube to evaluate stomach contents and decompress the stomach. You connect the NG tube to intermittent low wall suction.

What is likely going on with Mrs. Baker physiologically?

• Mrs. Bakers chronic heavy use of NSAID’s may have caused ulcers to form in the lining of her stomach and/or duodenum
• It is possible that these ulcers are now bleeding

What is the benefit to decompressing the stomach via NG tube?

• Decompressing the stomach removes the majority of stomach acid, thereby decreasing the irritation on the stomach lining
• The hope is to prevent further irritation to any bleeding ulcers

The UAP notifies you that Mrs. Baker’s blood pressure has dropped to 96/60. You enter the room and see that the suction canister is over halfway full of bright red blood.

What is your priority assessment at this time?

• Assess Mrs. Baker – LOC, heart and lung sounds, confirm the accuracy of vital signs
• Protect airway – suction if needed, minimize risk for aspiration

What may be happening to Mrs. Baker?

• She may have an ulcer that is bleeding more actively than before. With that amount of blood, it could possibly be an arterial bleed.

Mrs. Baker is pale, diaphoretic, and drowsy. Her heart rate is up to 122. You notify the provider who orders to transfuse 2 units of PRBC’s and calls the Gastroenterology team for a STAT EGD. Within 30 minutes the patient is taken to the GI lab for an EGD, where they find two slow-bleeding gastric ulcers, which they cauterize, and 1 arterial bleed which they repair as well.  Mrs. Baker returns to the unit post-procedure for observation.

What are nursing priorities for Mrs. Baker after this procedure?

• Keep NPO until gag reflex returns
• Assess and monitor output from NG tube
• Monitor vital signs closely
• Monitor LOC as she awakens from sedatives used during the procedure
• Ensure the full 2 units of PRBC’s were administered. If not, continue transfusion.

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Peptic Ulcer Disease Questions & Answers

• Author: BS Anand, MD; Chief Editor: Philip O Katz, MD, FACP, FACG  more...
• Sections Peptic Ulcer Disease
• Pathophysiology
• Epidemiology
• Patient Education
• Physical Examination
• Approach Considerations
• Radiography
• Angiography
• Serum Gastrin Level
• Secretin Stimulation Test
• Biopsy and Histologic Findings
• Emergency Department Workup
• Bleeding Peptic Ulcers
• H pylori Infection
• Medical Management of NSAID Ulcers
• Emergency Department Care
• Complications of Peptic Ulcer Disease
• Consultations
• Long-Term Monitoring
• Perforated and Bleeding Peptic Ulcer Clinical Practice Guidelines (2020)
• ASGE Guidelines for Sedation and Anesthesia in Gastrointestinal Endoscopy (2018)
• ACG H Pylori Infection Guidelines (2017)
• Medication Summary
• Proton Pump Inhibitors
• H2-Receptor Antagonists
• Antimicrobials
• Antidiarrheal Agents
• Cytoprotective Agents
• Questions & Answers
• Media Gallery

How are gastric and duodenal ulcers differentiated?

What are the “alarm features” of peptic ulcer disease that necessitate immediate referral to a gastroenterologist?

How is a diagnosis of peptic ulcer disease (PUD) confirmed?

Why is upper GI endoscopy the preferred diagnostic test for peptic ulcer disease (PUD)?

How is peptic ulcer disease (PUD) treated?

How is NSAID-associated peptic ulcer disease (PUD) treated?

When is surgical intervention indicated in in the treatment of peptic ulcer disease (PUD)?

What is the anatomy of the vagal innervation of the abdominal viscera and how does it affect surgical procedures for peptic ulcer disease (PUD)?

What is the pathogenesis of peptic ulcer disease (PUD)?

How do peptic ulcer disease (PUD) occur?

What is the role of H pylori infection (HPI) in peptic ulcer disease (PUD)?

What is the relationship between H pylori gastritis and duodenal ulceration?

What is the etiology of peptic ulcer disease (PUD)?

What is the most common cause of peptic ulcer disease (PUD)?

Which factors increase the risk of NSAID-related peptic ulcer disease (PUD)?

Which factors increase the risk for peptic ulcer disease (PUD) in patients taking low-dose aspirin?

Does the combination of H pylori infection (HPI) and NSAID use increase the risk of developing peptic ulcer disease (PUD)?

What is the prevalence of NSAID gastropathy in children?

Do corticosteroids increase the risk of peptic ulcer disease (PUD)?

Does smoking, alcohol, or caffeine increase the risk of peptic ulcer disease (PUD)?

Which physiologic stress conditions may cause peptic ulcer disease (PUD)?

What are Cushing ulcers?

Which patients are at an increased risk for stress ulceration and upper- GI hemorrhage?

Which hypersecretory states may cause peptic ulcer disease (PUD)?

Which physiologic factors increase the risk of duodenal ulcers?

What is the role of accelerated gastric emptying in peptic ulcer disease (PUD)?

Does cold climate increase the risk of developing peptic ulcer disease (PUD)?

What is the role of genetics in peptic ulcer disease (PUD)?

What are the less common causes of peptic ulcer disease (PUD)?

What is the prevalence of peptic ulcer disease (PUD) in the US?

What is the US incidence of peptic ulcer disease?

Is peptic ulcer disease more common in in males or females?

What is the international prevalence of peptic ulcer disease?

How is peptic ulcer disease treated?

What is the incidence of NSAID-related ulcers?

What is the mortality rate for peptic ulcer disease?

Which factors increase the mortality risk associated with emergency surgery for peptic ulcer perforation?

What is the mortality rate for patients undergoing surgery for perforated peptic ulcer?

Which agents are potentially injurious to patients with peptic ulcer disease?

Which counseling may be beneficial for patients with peptic ulcer disease (PUD)?

Presentation

Which history details suggest peptic ulcer disease (PUD)?

Which pain characteristics suggest duodenal ulcer?

What are the symptoms of gastric outlet obstruction?

What are the signs and symptoms of peptic ulcer disease (PUD)?

What are the alarm features of peptic ulcer disease (PUD) that necessitate immediate referral to a gastroenterologist?

Which clinical findings suggest uncomplicated peptic ulcer disease (PUD)?

What are the signs and symptoms of perforated peptic ulcer disease (PUD)?

How is functional dyspepsia diagnosed?

What part of the GI tract is involved in Crohn ulceration?

What is Zollinger-Ellison syndrome (ZES)?

What are the differential diagnoses for Peptic Ulcer Disease?

What is the role of H pylori testing in the diagnosis of peptic ulcer disease (PUD)?

Which lab tests should be performed in suspected peptic ulcer disease (PUD)?

How is the presence of H pylori detected in peptic ulcer disease (PUD)?

Which test finding indicates the presence of H pylori infection?

How do urea breath tests detect H pylori infection?

What is the role of histopathology in the diagnosis of H pylori infection (HPI)?

What is the preferred test for the diagnosis of peptic ulcer disease (PUD)?

What is the appearance of duodenal ulcers on endoscopy?

What is the most common finding in individuals who undergo endoscopy for dyspepsia?

When is a chest X-ray indicated for diagnosis of peptic ulcer disease (PUD)?

When is angiography indicated for suspected peptic ulcer disease (PUD)?

When should screening for Zollinger-Ellison syndrome (ZES) be performed in patients with peptic ulcer disease (PUD)?

When is a secretin simulation test required in in the workup of peptic ulcer disease (PUD)?

How accurate is a biopsy in the diagnosis of gastric cancer?

What is the histology of gastric ulcers?

What testing should be performed in the emergency department (ED) for suspected peptic ulcer disease (PUD)?

Which factors determine the treatment of peptic ulcer disease (PUD)?

Which treatment options are available for peptic ulcer disease (PUD)?

What is the role of endoscopy in the management of peptic ulcer disease (PUD)?

Can peptic ulcer disease (PUD) be cured?

What factors determine if endoscopy should be performed in the treatment of peptic ulcer disease (PUD)?

What are the indications for urgent surgery in peptic ulcer disease (PUD)?

How are bleeding peptic ulcers treated?

What are the high-risk stigmata in bleeding peptic ulcer?

Which endoscopic therapy modalities are available for treating peptic ulcer disease (PUD)?

What is the role of hemoclips in the treatment of peptic ulcer disease (PUD)?

What is the role of EGD in the treatment of peptic ulcer disease (PUD)?

Which risk factors predict rebleeding following endoscopic hemostatic therapy (EHT) in peptic ulcer disease (PUD)?

What is the role of acid suppression in the treatment of peptic ulcer disease (PUD)?

Which classes of acid-suppressing medications are currently used in the treatment of peptic ulcer disease (PUD)?

What is the role of PPIs in the treatment of peptic ulcer disease (PUD)?

Is a high-dose PPI regimen more effective than a standard-dose regimen in the treatment of peptic ulcer disease (PUD)?

Does parenteral PPI therapy decrease rebleeding in peptic ulcer disease (PUD)?

What is the overall efficacy of parenteral PPI therapy in peptic ulcer disease (PUD)?

What are the ACG guidelines for the primary treatment of H pylori infection (HPI)?

Who should be considered for testing of H pylori infection (HPI)?

What are the ACG guidelines for prevention of NSAID-related ulcer complications?

How is peptic ulcer disease (PUD) managed when NSAID therapy cannot be discontinued?

How are active NSAID-related ulcers treated?

What are the 2009 ACG treatment guidelines for peptic ulcer disease (PUD) in patients who require NSAID and low-dose aspirin therapy?

How are NSAID-related ulcers prevented?

Which patients should be considered for prophylactic therapy for peptic ulcer disease (PUD)?

What prophylactic regimen is effective in reducing the risk of NSAID-related ulcers?

Is aspirin plus esomeprazole (Nexium) effective in preventing recurrent gastric ulcer bleeding?

Is treatment with combined esomeprazole (Nexium) and clopidogrel (Plavix) effective in reducing recurrence of peptic ulcers?

What are the treatment goals for peptic ulcer disease (PUD) in the emergency department (ED)?

How is high-risk determined in peptic ulcer disease (PUD)?

What drug treatments are available for symptomatic treatment of peptic ulcer disease (PUD)?

How are massive gastric bleeds managed in patients with peptic ulcer disease (PUD)?

When is surgical management of peptic ulcer disease (PUD) indicated?

What are the surgical options for the management of peptic ulcer disease (PUD)?

When is laparoscopic surgery for perforated ulcer contraindicated?

What are the potential complications after surgical treatment of a perforated peptic ulcer?

What are the dietary restrictions for patients with peptic ulcer disease (PUD)?

What are potential complications of peptic ulcer disease (PUD)?

What are the potential health risks of gastric ulcers?

What test should be performed in a patient with persistent nonhealing gastric ulcer?

When is surgical consultation needed in the treatment of peptic ulcer disease (PUD)?

Which maintenance therapy is indicated in high-risk patients with peptic ulcer disease (PUD)?

Which maintenance therapies are effective for recurrent, refractory, or complicated ulcers?

How common is peptic ulcer rebleeding after H pylori eradication?

What are the WSES guidelines for the diagnosis and treatment of bleeding peptic ulcers?

What are the WSES guidelines for the diagnosis and treatment of perforated peptic ulcer?

What are the ASGE guidelines for sedation and anesthesia in gastrointestinal endoscopy?

What are the ACG recommendations for testing for H pylori?

What are the ACG guidelines for the treatment of H pylori infection (HPI)?

Medications

What are the goals of pharmacotherapy for peptic ulcer disease (PUD)?

What is the treatment for H pylori infection (HPI)?

Can NSAID-induced ulcers be prevented?

Which medications in the drug class Proton Pump Inhibitors are used in the treatment of Peptic Ulcer Disease?

Which medications in the drug class H2-Receptor Antagonists are used in the treatment of Peptic Ulcer Disease?

Which medications in the drug class Antimicrobials are used in the treatment of Peptic Ulcer Disease?

Which medications in the drug class Antidiarrheal Agents are used in the treatment of Peptic Ulcer Disease?

Which medications in the drug class Cytoprotective Agents are used in the treatment of Peptic Ulcer Disease?

[Guideline] Chey WD, Wong BC. American College of Gastroenterology guideline on the management of Helicobacter pylori infection. Am J Gastroenterol . 2007 Aug. 102(8):1808-25. [QxMD MEDLINE Link] .

Javid G, Zargar SA, U-Saif R, et al. Comparison of p.o. or i.v. proton pump inhibitors on 72-h intragastric pH in bleeding peptic ulcer. J Gastroenterol Hepatol . 2009 Jul. 24(7):1236-43. [QxMD MEDLINE Link] .

Lai KC, Lam SK, Chu KM, et al. Lansoprazole for the prevention of recurrences of ulcer complications from long-term low-dose aspirin use. N Engl J Med . 2002 Jun 27. 346(26):2033-8. [QxMD MEDLINE Link] .

Lai KC, Lam SK, Chu KM, et al. Lansoprazole reduces ulcer relapse after eradication of Helicobacter pylori in nonsteroidal anti-inflammatory drug users--a randomized trial. Aliment Pharmacol Ther . 2003 Oct 15. 18(8):829-36. [QxMD MEDLINE Link] .

Sung JJ, Tsoi KK, Ma TK, Yung MY, Lau JY, Chiu PW. Causes of mortality in patients with peptic ulcer bleeding: a prospective cohort study of 10,428 cases. Am J Gastroenterol . 2010 Jan. 105(1):84-9. [QxMD MEDLINE Link] .

Pietroiusti A, Luzzi I, Gomez MJ, et al. Helicobacter pylori duodenal colonization is a strong risk factor for the development of duodenal ulcer. Aliment Pharmacol Ther . 2005 Apr 1. 21(7):909-15. [QxMD MEDLINE Link] .

Laine L, Curtis SP, Cryer B, Kaur A, Cannon CP. Risk factors for NSAID-associated upper GI clinical events in a long-term prospective study of 34 701 arthritis patients. Aliment Pharmacol Ther . 2010 Nov. 32(10):1240-8. [QxMD MEDLINE Link] .

Ruigomez A, Johansson S, Nagy P, Martin-Perez M, Rodriguez LA. Risk of uncomplicated peptic ulcer disease in a cohort of new users of low-dose acetylsalicylic acid for secondary prevention of cardiovascular events. BMC Gastroenterol . 2014 Dec 10. 14:205. [QxMD MEDLINE Link] .

ReStore, National Centre for Research Methods. Geographical referencing learning resources: Townsend deprivation index. Available at http://www.restore.ac.uk/geo-refer/36229dtuks00y19810000.php . Accessed: December 20, 2018.

Vergara M, Catalan M, Gisbert JP, Calvet X. Meta-analysis: role of Helicobacter pylori eradication in the prevention of peptic ulcer in NSAID users. Aliment Pharmacol Ther . 2005 Jun 15. 21(12):1411-8. [QxMD MEDLINE Link] .

Berezin SH, Bostwick HE, Halata MS, Feerick J, Newman LJ, Medow MS. Gastrointestinal bleeding in children following ingestion of low-dose ibuprofen. J Pediatr Gastroenterol Nutr . 2007 Apr. 44(4):506-8. [QxMD MEDLINE Link] .

Gulmez SE, Lassen AT, Aalykke C, et al. Spironolactone use and the risk of upper gastrointestinal bleeding: a population-based case-control study. Br J Clin Pharmacol . 2008 Aug. 66(2):294-9. [QxMD MEDLINE Link] . [Full Text] .

Lewis JD, Strom BL, Localio AR, et al. Moderate and high affinity serotonin reuptake inhibitors increase the risk of upper gastrointestinal toxicity. Pharmacoepidemiol Drug Saf . 2008 Apr. 17(4):328-35. [QxMD MEDLINE Link] .

Aldoori WH, Giovannucci EL, Stampfer MJ, Rimm EB, Wing AL, Willett WC. A prospective study of alcohol, smoking, caffeine, and the risk of duodenal ulcer in men. Epidemiology . 1997 Jul. 8(4):420-4. [QxMD MEDLINE Link] .

Sonnenberg A, Muller-Lissner SA, Vogel E, et al. Predictors of duodenal ulcer healing and relapse. Gastroenterology . 1981 Dec. 81(6):1061-7. [QxMD MEDLINE Link] .

Koivisto TT, Voutilainen ME, Farkkila MA. Effect of smoking on gastric histology in Helicobacter pylori-positive gastritis. Scand J Gastroenterol . 2008. 43(10):1177-83. [QxMD MEDLINE Link] .

Schubert ML, Peura DA. Control of gastric acid secretion in health and disease. Gastroenterology . 2008 Jun. 134(7):1842-60. [QxMD MEDLINE Link] .

Yuan XG, Xie C, Chen J, Xie Y, Zhang KH, Lu NH. Seasonal changes in gastric mucosal factors associated with peptic ulcer bleeding. Exp Ther Med . 2015 Jan. 9(1):125-30. [QxMD MEDLINE Link] . [Full Text] .

Lanas A, Chan FKL. Peptic ulcer disease. Lancet . 2017 Aug 5. 390(10094):613-24. [QxMD MEDLINE Link] .

Peptic ulcer. OMICS International. Available at https://www.omicsonline.org/united-states/peptic-ulcer-peer-reviewed-pdf-ppt-articles/ . Accessed: August 1, 2019.

Malik TF, Gnanapandithan K, Singh K. Peptic ulcer disease. StatPearls [Internet] . 2021 Jan. [QxMD MEDLINE Link] . [Full Text] .

Sung JJ, Kuipers EJ, El-Serag HB. Systematic review: the global incidence and prevalence of peptic ulcer disease. Aliment Pharmacol Ther . 2009 May 1. 29 (9):938-46. [QxMD MEDLINE Link] .

Cai S, Garcia Rodriguez LA, Masso-Gonzalez EL, Hernandez-Diaz S. Uncomplicated peptic ulcer in the UK: trends from 1997 to 2005. Aliment Pharmacol Ther . 2009 Nov 15. 30(10):1039-48. [QxMD MEDLINE Link] .

Azhari H, Underwood F, King J, et al. The global incidence of peptic ulcer disease and its complications at the turn of the 21st century: a systematic review. J Can Assoc Gastroenterol . 2018 Feb. 1(suppl_2):61-2. [Full Text] .

Leontiadis GI, Sreedharan A, Dorward S, et al. Systematic reviews of the clinical effectiveness and cost-effectiveness of proton pump inhibitors in acute upper gastrointestinal bleeding. Health Technol Assess . 2007 Dec. 11(51):iii-iv, 1-164. [QxMD MEDLINE Link] .

Bardou M, Toubouti Y, Benhaberou-Brun D, Rahme E, Barkun AN. High dose proton pump inhibition decrease both re-bleeding and mortality in high-risk patients with acute peptic ulcer bleeding [abstract]. Gastroenterology . 2003. 123(suppl 1):A625.

Bardou M, Youssef M, Toubouti Y, et al. Newer endoscopic therapies decrease both re-bleeding and mortality in high risk patients with acute peptic ulcer bleeding: a series of meta-analyses [abstract]. Gastroenterology . 2003. 123:A239.

Gisbert JP, Pajares R, Pajares JM. Evolution of Helicobacter pylori therapy from a meta-analytical perspective. Helicobacter . 2007 Nov. 12 suppl 2:50-8. [QxMD MEDLINE Link] .

Svanes C, Lie RT, Svanes K, Lie SA, Soreide O. Adverse effects of delayed treatment for perforated peptic ulcer. Ann Surg . 1994 Aug. 220(2):168-75. [QxMD MEDLINE Link] . [Full Text] .

Sengupta TK, Prakash G, Ray S, Kar M. Surgical management of peptic perforation in a tertiary care center: a retrospective study. Niger Med J . 2020 Nov-Dec. 61(6):328-33. [QxMD MEDLINE Link] . [Full Text] .

Thorsen K, Soreide JA, Soreide K. Long-term mortality in patients operated for perforated peptic ulcer: factors limiting longevity are dominated by older age, comorbidity burden and severe postoperative complications. World J Surg . 2017 Feb. 41(2):410-8. [QxMD MEDLINE Link] .

Hung KW, Knotts RM, Faye AS, et al. Factors associated with adherence to Helicobacter pylori testing during hospitalization for bleeding peptic ulcer disease. Clin Gastroenterol Hepatol . 2020 May. 18(5):1091-1098.e1. [QxMD MEDLINE Link] .

[Guideline] Chey WD, Leontiadis GI, Howden CW, Moss SF. ACG Clinical Guideline: Treatment of Helicobacter pylori infection. Am J Gastroenterol . 2017 Feb. 112(2):212-39. [QxMD MEDLINE Link] .

[Guideline] Early DS, Lightdale JR, Vargo JJ 2nd, et al, for the ASGE Standards of Practice Committee. Guidelines for sedation and anesthesia in GI endoscopy. Gastrointest Endosc . 2018 Feb. 87(2):327-37. [QxMD MEDLINE Link] .

Ramakrishnan K, Salinas RC. Peptic ulcer disease. Am Fam Physician . 2007 Oct 1. 76(7):1005-12. [QxMD MEDLINE Link] .

Ford AC, Marwaha A, Lim A, Moayyedi P. What is the prevalence of clinically significant endoscopic findings in subjects with dyspepsia? Systematic review and meta-analysis. Clin Gastroenterol Hepatol . 2010 Oct. 8(10):830-7, 837.e1-2. [QxMD MEDLINE Link] .

Zullo A, Hassan C, Campo SM, Morini S. Bleeding peptic ulcer in the elderly: risk factors and prevention strategies. Drugs Aging . 2007. 24(10):815-28. [QxMD MEDLINE Link] .

Udd M, Miettinen P, Palmu A, et al. Analysis of the risk factors and their combinations in acute gastroduodenal ulcer bleeding: a case-control study. Scand J Gastroenterol . 2007 Dec. 42(12):1395-403. [QxMD MEDLINE Link] .

Jensen DM, Eklund S, Persson T, et al. Reassessment of rebleeding risk of Forrest IB (oozing) peptic ulcer bleeding in a large international randomized trial. Am J Gastroenterol . 2017 Mar. 112(3):441-6. [QxMD MEDLINE Link] . [Full Text] .

Wang HM, Hsu PI, Lo GH, et al. Comparison of hemostatic efficacy for argon plasma coagulation and distilled water injection in treating high-risk bleeding ulcers. J Clin Gastroenterol . 2009 Nov-Dec. 43(10):941-5. [QxMD MEDLINE Link] .

Khodadoostan M, Karami-Horestani M, Shavakhi A, Sebghatollahi V. Endoscopic treatment for high-risk bleeding peptic ulcers: A randomized, controlled trial of epinephrine alone with epinephrine plus fresh frozen plasma. J Res Med Sci . 2016. 21:135. [QxMD MEDLINE Link] .

Larssen L, Moger T, Bjornbeth BA, Lygren I, Klow NE. Transcatheter arterial embolization in the management of bleeding duodenal ulcers: a 5.5-year retrospective study of treatment and outcome. Scand J Gastroenterol . 2008. 43(2):217-22. [QxMD MEDLINE Link] .

Travis AC, Wasan SK, Saltzman JR. Model to predict rebleeding following endoscopic therapy for non-variceal upper gastrointestinal hemorrhage. J Gastroenterol Hepatol . 2008 Oct. 23(10):1505-10. [QxMD MEDLINE Link] .

Elmunzer BJ, Young SD, Inadomi JM, Schoenfeld P, Laine L. Systematic review of the predictors of recurrent hemorrhage after endoscopic hemostatic therapy for bleeding peptic ulcers. Am J Gastroenterol . 2008 Oct. 103(10):2625-32; quiz 2633. [QxMD MEDLINE Link] .

Chiu PW, Ng EK, Cheung FK, et al. Predicting mortality in patients with bleeding peptic ulcers after therapeutic endoscopy. Clin Gastroenterol Hepatol . 2009 Mar. 7(3):311-6; quiz 253. [QxMD MEDLINE Link] .

Kikkawa A, Iwakiri R, Ootani H, et al. Prevention of the rehaemorrhage of bleeding peptic ulcers: effects of Helicobacter pylori eradication and acid suppression. Aliment Pharmacol Ther . 2005 Jun. 21 Suppl 2:79-84. [QxMD MEDLINE Link] .

Gisbert JP, Calvet X, Feu F, et al. Eradication of Helicobacter pylori for the prevention of peptic ulcer rebleeding. Helicobacter . 2007 Aug. 12(4):279-86. [QxMD MEDLINE Link] .

Boparai V, Rajagopalan J, Triadafilopoulos G. Guide to the use of proton pump inhibitors in adult patients. Drugs . 2008. 68(7):925-47. [QxMD MEDLINE Link] .

Barkun A, Bardou M, Marshall JK, for the Nonvariceal Upper GI Bleeding Consensus Conference Group. Consensus recommendations for managing patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med . 2003 Nov 18. 139(10):843-57. [QxMD MEDLINE Link] .

Cote GA, Howden CW. Potential adverse effects of proton pump inhibitors. Curr Gastroenterol Rep . 2008 Jun. 10(3):208-14. [QxMD MEDLINE Link] .

Laine L, Shah A, Bemanian S. Intragastric pH with oral vs intravenous bolus plus infusion proton-pump inhibitor therapy in patients with bleeding ulcers. Gastroenterology . 2008 Jun. 134(7):1836-41. [QxMD MEDLINE Link] .

Chan WH, Khin LW, Chung YF, Goh YC, Ong HS, Wong WK. Randomized controlled trial of standard versus high-dose intravenous omeprazole after endoscopic therapy in high-risk patients with acute peptic ulcer bleeding. Br J Surg . 2011 May. 98(5):640-4. [QxMD MEDLINE Link] .

Andriulli A, Loperfido S, Focareta R, et al. High- versus low-dose proton pump inhibitors after endoscopic hemostasis in patients with peptic ulcer bleeding: a multicentre, randomized study. Am J Gastroenterol . 2008 Dec. 103(12):3011-8. [QxMD MEDLINE Link] .

Sari YS, Can D, Tunali V, Sahin O, Koc O, Bender O. H pylori: treatment for the patient only or the whole family?. World J Gastroenterol . 2008 Feb 28. 14(8):1244-7. [QxMD MEDLINE Link] . [Full Text] .

Konno M, Yokota S, Suga T, Takahashi M, Sato K, Fujii N. Predominance of mother-to-child transmission of Helicobacter pylori infection detected by random amplified polymorphic DNA fingerprinting analysis in Japanese families. Pediatr Infect Dis J . 2008 Nov. 27(11):999-1003. [QxMD MEDLINE Link] .

Singh V, Mishra S, Maurya P, et al. Drug resistance pattern and clonality in H. pylori strains. J Infect Dev Ctries . 2009 Mar 1. 3(2):130-6. [QxMD MEDLINE Link] .

Ram M R, Teh X, Rajakumar T, et al. Polymorphisms in the host CYP2C19 gene and antibiotic-resistance attributes of Helicobacter pylori isolates influence the outcome of triple therapy. J Antimicrob Chemother . 2019 Jan 1. 74(1):11-6. [QxMD MEDLINE Link] .

[Guideline] Lanza FL, Chan FK, Quigley EM, for the Practice Parameters Committee of the American College of Gastroenterology. Guidelines for prevention of NSAID-related ulcer complications. Am J Gastroenterol . 2009 Mar. 104(3):728-38. [QxMD MEDLINE Link] . [Full Text] .

Chan FK, Hung LC, Suen BY, et al. Celecoxib versus diclofenac and omeprazole in reducing the risk of recurrent ulcer bleeding in patients with arthritis. N Engl J Med . 2002 Dec 26. 347(26):2104-10. [QxMD MEDLINE Link] .

Yang M, He M, Zhao M, et al. Proton pump inhibitors for preventing non-steroidal anti-inflammatory drug induced gastrointestinal toxicity: a systematic review. Curr Med Res Opin . 2017 Jun. 33(6):973-80. [QxMD MEDLINE Link] .

Chan FK, Ching JY, Hung LC, et al. Clopidogrel versus aspirin and esomeprazole to prevent recurrent ulcer bleeding. N Engl J Med . 2005 Jan 20. 352(3):238-44. [QxMD MEDLINE Link] . [Full Text] .

Lai KC, Chu KM, Hui WM, et al. Esomeprazole with aspirin versus clopidogrel for prevention of recurrent gastrointestinal ulcer complications. Clin Gastroenterol Hepatol . 2006 Jul. 4(7):860-5. [QxMD MEDLINE Link] .

Hsu PI, Lai KH, Liu CP. Esomeprazole with clopidogrel reduces peptic ulcer recurrence, compared with clopidogrel alone, in patients with atherosclerosis. Gastroenterology . 2011 Mar. 140(3):791-8. [QxMD MEDLINE Link] .

[Guideline] Talley NJ, Vakil N, for the Practice Parameters Committee of the American College of Gastroenterology. Guidelines for the management of dyspepsia. Am J Gastroenterol . 2005 Oct. 100(10):2324-37. [QxMD MEDLINE Link] .

Tajima A, Koizumi K, Suzuki K, et al. Proton pump inhibitors and recurrent bleeding in peptic ulcer disease. J Gastroenterol Hepatol . 2008 Dec. 23 suppl 2:S237-41. [QxMD MEDLINE Link] .

McConnell DB, Baba GC, Deveney CW. Changes in surgical treatment of peptic ulcer disease within a veterans hospital in the 1970s and the 1980s. Arch Surg . 1989 Oct. 124(10):1164-7. [QxMD MEDLINE Link] .

Gisbert JP, Calvet X, Cosme A, et al, for the H. pylori Study Group of the Asociacion Espanola de Gastroenterologia (Spanish Gastroenterology Association). Long-term follow-up of 1,000 patients cured of Helicobacter pylori infection following an episode of peptic ulcer bleeding. Am J Gastroenterol . 2012 Aug. 107(8):1197-204. [QxMD MEDLINE Link] .

[Guideline] Tarasconi A, Coccolini F, Biffl WL, et al. Perforated and bleeding peptic ulcer: WSES guidelines. World J Emerg Surg . 2020. 15:3. [QxMD MEDLINE Link] . [Full Text] .

Berne TV, Donovan AJ. Nonoperative treatment of perforated duodenal ulcer. Arch Surg . 1989 Jul. 124(7):830-2. [QxMD MEDLINE Link] .

Donovan AJ, Berne TV, Donovan JA. Perforated duodenal ulcer: an alternative therapeutic plan. Arch Surg . 1998 Nov. 133(11):1166-71. [QxMD MEDLINE Link] .

Wangensteen OH. Non-operative treatment of localized perforations of the duodenum. Proc Minn Acad Med . 1935. 18:477-80.

Strand DS, Kim D, Peura DA. 25 years of proton pump inhibitors: a comprehensive review. Gut Liver . 2017 Jan 15. 11(1):27-37. [QxMD MEDLINE Link] .

Kajihara Y, Shimoyama T, Mizuki I. Analysis of the cost-effectiveness of using vonoprazan-amoxicillin-clarithromycin triple therapy for first-line Helicobacter pylori eradication. Scand J Gastroenterol . 2017 Feb. 52(2):238-41. [QxMD MEDLINE Link] .

Ng JC, Yeomans ND. Helicobacter pylori infection and the risk of upper gastrointestinal bleeding in low dose aspirin users: systematic review and meta-analysis. Med J Aust . 2018 Sep 1. 209(7):306-11. [QxMD MEDLINE Link] .

Mirabella A, Fiorentini T, Tutino R, et al. Laparoscopy is an available alternative to open surgery in the treatment of perforated peptic ulcers: a retrospective multicenter study. BMC Surg . 2018 Sep 25. 18(1):78. [QxMD MEDLINE Link] . [Full Text] .

Havens JM, Castillo-Angeles M, Nitzschke SL, Salim A. Disparities in peptic ulcer disease: A nationwide study. Am J Surg . 2018 Dec. 216(6):1127-8. [QxMD MEDLINE Link] .

[Guideline] Satoh K, Yoshino J, Akamatsu T, et al. Evidence-based clinical practice guidelines for peptic ulcer disease 2015. J Gastroenterol . 2016 Mar. 51(3):177-94. [QxMD MEDLINE Link] .

Lau JY, Sung J, Hill C, Henderson C, Howden CW, Metz DC. Systematic review of the epidemiology of complicated peptic ulcer disease: incidence, recurrence, risk factors and mortality. Digestion . 2011. 84(2):102-13. [QxMD MEDLINE Link] .

Sonnenberg A. Temporal trends and geographical variations of peptic ulcer disease. Aliment Pharmacol Ther . 1995. 9 suppl 2:3-12. [QxMD MEDLINE Link] .

Mohamed WA, Schaalan MF, Ramadan B. The expression profiling of circulating miR-204, miR-182, and lncRNA H19 as novel potential biomarkers for the progression of peptic ulcer to gastric cancer. J Cell Biochem . 2019 Aug. 120(8):13464-77. [QxMD MEDLINE Link] .

Sanaii A, Shirzad H, Haghighian M, et al. Role of Th22 cells in Helicobacter pylori-related gastritis and peptic ulcer diseases. Mol Biol Rep . 2019 Dec. 46(6):5703-12. [QxMD MEDLINE Link] .

• Peptic ulcer disease. Vagal innervation of the stomach.
• Peptic ulcer disease. Gastric ulcer with a punched-out ulcer base and whitish fibrinoid exudates.
• Peptic ulcer disease. Gastric ulcer (lesser curvature) with a punched-out ulcer base with a whitish exudate.
• Peptic ulcer disease. Gastric cancer. Note the irregular heaped-up overhanging margins.
• Peptic ulcer disease. Gastric cancer with an ulcerated mass.
• Peptic ulcer disease. Gross pathology specimen of a gastric ulcer.
• Peptic ulcer disease. Endoscopic view of an ulcer (at the upper center) in the wall of the duodenum, the first part of the small intestine. This ulcer is an open sore. Image courtesy of Science Source | Gastrolab.
• Peptic ulcer disease. Duodenal ulcer in a 65-year-old man with osteoarthritis who presented with hematemesis and melena. The patient took naproxen on a daily basis.

Contributor Information and Disclosures

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases , American College of Gastroenterology , American Gastroenterological Association , American Society for Gastrointestinal Endoscopy Disclosure: Nothing to disclose.

Philip O Katz, MD, FACP, FACG Chairman, Division of Gastroenterology, Albert Einstein Medical Center; Clinical Professor of Medicine, Jefferson Medical College of Thomas Jefferson University Philip O Katz, MD, FACP, FACG is a member of the following medical societies: American College of Gastroenterology , American College of Physicians , American Gastroenterological Association , American Society for Gastrointestinal Endoscopy Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Medtronic<br/>Received income in an amount equal to or greater than $250 from: Torax medical: pfizer consumer, .

Faisal Aziz, MD Assistant Professor of Surgery, Divsion of Vascular and Endovascular Surgery, Department of Surgery, Pennsylvania State University College of Medicine

Faisal Aziz, MD is a member of the following medical societies: American College of Surgeons and American Medical Association

Disclosure: Nothing to disclose.

Simmy Bank, MD Chair, Professor, Department of Internal Medicine, Division of Gastroenterology, Long Island Jewish Hospital, Albert Einstein College of Medicine

Jeffrey Glenn Bowman, MD, MS Consulting Staff, Highfield MRI

Carmen Cuffari, MD Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine

Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology , American Gastroenterological Association , North American Society for Pediatric Gastroenterology, Hepatology and Nutrition , and Royal College of Physicians and Surgeons of Canada

Brian James Daley, MD, MBA, FACS, FCCP, CNSC Professor and Program Director, Department of Surgery, Chief, Division of Trauma and Critical Care, University of Tennessee Health Science Center College of Medicine

Brian James Daley, MD, MBA, FACS, FCCP, CNSC is a member of the following medical societies: American Association for the Surgery of Trauma , American College of Chest Physicians , American College of Surgeons , American Medical Association , Association for Academic Surgery , Association for Surgical Education , Eastern Association for the Surgery of Trauma , Shock Society , Society of Critical Care Medicine , Southeastern Surgical Congress , and Tennessee Medical Association

Shane M Devlin, MD, FRCP(C) Clinical Assistant Professor, Department of Internal Medicine, Peter Lougheed Center, University of Calgary, Canada

Shane M Devlin, MD, FRCP(C) is a member of the following medical societies: American Gastroenterological Association , Canadian Association of Gastroenterology , Canadian Medical Association , and Royal College of Physicians and Surgeons of Canada

Steven C Dronen, MD, FAAEM Chair, Department of Emergency Medicine, LeConte Medical Center

Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine

George T Fantry, MD Associate Professor of Medicine, Department of Internal Medicine, Division of Gastroenterology, University of Maryland School of Medicine

George T Fantry, MD is a member of the following medical societies: American College of Gastroenterology and American Gastroenterological Association

John Geibel, MD, DSc, MA Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director, Surgical Research, Department of Surgery, Yale-New Haven Hospital

John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association , American Physiological Society , American Society of Nephrology , Association for Academic Surgery , International Society of Nephrology , New York Academy of Sciences , and Society for Surgery of the Alimentary Tract

Disclosure: AMGEN Royalty Consulting; Ardelyx Ownership interest Board membership

David Greenwald, MD Associate Professor of Clinical Medicine, Fellowship Program Director, Department of Medicine, Division of Gastroenterology, Montefiore Medical Center, Albert Einstein College of Medicine

David Greenwald, MD is a member of the following medical societies: Alpha Omega Alpha , American College of Gastroenterology , American College of Physicians , American Gastroenterological Association , American Society for Gastrointestinal Endoscopy , and New York Society for Gastrointestinal Endoscopy

Harsh Grewal, MD, FACS, FAAP Clinical Professor of Surgery, Temple University School of Medicine; Chief, Division of Pediatric Surgery, Cooper University Hospital

Harsh Grewal, MD, FACS, FAAP is a member of the following medical societies: American Academy of Pediatrics , American College of Surgeons , American Pediatric Surgical Association , Association for Surgical Education , Children's Oncology Group , Eastern Association for the Surgery of Trauma , International Pediatric Endosurgery Group , Society of American Gastrointestinal and Endoscopic Surgeons , Society of Laparoendoscopic Surgeons , and SouthwesternSurgical Congress

Eugene Hardin, MD, FAAEM, FACEP Former Chair and Associate Professor, Department of Emergency Medicine, Charles Drew University of Medicine and Science; Former Chair, Department of Emergency Medicine, Martin Luther King Jr/Drew Medical Center

Andre Hebra, MD Chief, Division of Pediatric Surgery, Professor of Surgery and Pediatrics, Medical University of South Carolina College of Medicine; Surgeon-in-Chief, Medical University of South Carolina Children's Hospital

Andre Hebra, MD is a member of the following medical societies: Alpha Omega Alpha , American Academy of Pediatrics , American College of Surgeons , American Medical Association , American Pediatric Surgical Association , Children's Oncology Group , Florida Medical Association , International Pediatric Endosurgery Group , Society of American Gastrointestinal and Endoscopic Surgeons , Society of Laparoendoscopic Surgeons ,South Carolina Medical Association, Southeastern Surgical Congress , and Southern Medical Association

Juda Zvi Jona MD, FAAP(s), FACS, EUPSA, Clinical Professor of Surgery, Michigan State University College of Human Medicine; Clinical Professor of Surgery, Northwestern University, The Feinberg School of Medicine; Attending Senior Surgeon, Director of Pediatric Surgery Service, Surgical Executive Committee, Sparrow Hospital

Juda Zvi Jona is a member of the following medical societies: Alpha Omega Alpha , American Bronchoesophagological Association , American College of Surgeons , American Medical Association , American Pediatric Surgical Association , Association for Academic Surgery , British Association of Paediatric Surgeons , Central Surgical Association , Children's Oncology Group , and International Pediatric Endosurgery Group

Daryl Lau, MD, MPH, MSc, FRCP(C) Director of Translational Liver Research, Liver Center, Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center; Associate Professor of Medicine, Harvard Medical School

Daryl Lau, MD, MPH, MSc, FRCP(C) is a member of the following medical societies: American Association for the Study of Liver Diseases and American Gastroenterological Association

Tri H Le, MD Assistant Professor of Medicine, Division of Gastroenterology and Hepatology, Penn State Milton S Hershey Medical Center

Tri H Le, MD is a member of the following medical societies: American College of Gastroenterology , American Gastroenterological Association , American Society of Gastrointestinal Endoscopy , and Crohns and Colitis Foundation of America

Terence David Lewis, MBBS, FRACP, FRCPC, FACP Program Director, Internal Medicine Residency, & Assistant Chairman, Associate Professor, Department of Internal Medicine, Division of Gastroenterology, Loma Linda University Medical Center

Terence David Lewis, MBBS, FRACP, FRCPC, FACP is a member of the following medical societies: American College of Gastroenterology , American College of Physicians , American Gastroenterological Association , American Medical Association , California Medical Association , Royal College of Physicians and Surgeons of Canada , and Sigma Xi

B UK Li, MD Professor of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Director, Pediatric Fellowships and Gastroenterology Fellowship, Medical Director, Functional Gastrointestinal Disorders and Cyclic Vomiting Program, Medical College of Wisconsin; Attending Gastroenterologist, Children's Hospital of Wisconsin

B UK Li, MD is a member of the following medical societies: Alpha Omega Alpha , American Gastroenterological Association , and North American Society for Pediatric Gastroenterology and Nutrition

Chris A Liacouras MD, Director of Pediatric Endoscopy, Division of Gastroenterology and Nutrition, Children's Hospital of Philadelphia; Associate Professor of Pediatrics, University of Pennsylvania School of Medicine

Chris A Liacouras is a member of the following medical societies: American Gastroenterological Association

Wendi S Miller, MD Resident Physician, Department of Emergency Medicine, Emory University School of Medicine

Wendi S Miller, MD is a member of the following medical societies: American Academy of Emergency Medicine , American College of Emergency Physicians , American Medical Association , and Southern Medical Association

Robert K Minkes, MD, PhD Professor of Surgery, University of Texas Southwestern Medical Center at Dallas, Southwestern Medical School; Medical Director and Chief of Surgical Services, Children's Medical Center of Dallas-Legacy Campus

Robert K Minkes, MD, PhD is a member of the following medical societies: Alpha Omega Alpha , American College of Surgeons , American Medical Association , American Pediatric Surgical Association , and Phi Beta Kappa

Waqar A Qureshi, MD Associate Professor of Medicine, Chief of Endoscopy, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine and Veterans Affairs Medical Center

Waqar A Qureshi, MD is a member of the following medical societies: American College of Gastroenterology , American College of Physicians , American Gastroenterological Association , and American Society for Gastrointestinal Endoscopy

Erick F Rivas, MD, PT Resident Physician, Department of Surgery, Michigan State University College of Human Medicine

Erick F Rivas, MD, PT is a member of the following medical societies: American College of Surgeons

Ameesh Shah, MD Assistant Professor of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Memorial Hospital

Ameesh Shah, MD is a member of the following medical societies: North American Society for Pediatric Gastroenterology and Nutrition

Philip Shayne MD, Associate Professor, Program Director and Vice Chair for Education, Department of Emergency Medicine, Emory University School of Medicine

Philip Shayne is a member of the following medical societies: American College of Emergency Physicians , American Medical Association , Council of Emergency Medicine Residency Directors , and Society for Academic Emergency Medicine

Sanjeeb Shrestha, MD Consulting Staff, Division of Gastroenterology, Gastroenterology Care Consultants

Sanjeeb Shrestha, MD is a member of the following medical societies: American College of Gastroenterology , American Gastroenterological Association , and American Society of Gastrointestinal Endoscopy

Mutaz I Sultan, MBChB Makassed Hospital, Israel

Mutaz I Sultan, MBChB is a member of the following medical societies: American Gastroenterological Association and North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Alan BR Thomson, MD Professor of Medicine, Division of Gastroenterology, University of Alberta, Canada

Alan BR Thomson, MD is a member of the following medical societies: Alberta Medical Association , American College of Gastroenterology , American Gastroenterological Association , Canadian Association of Gastroenterology , Canadian Medical Association , College of Physicians and Surgeons of Alberta , and Royal College of Physicians and Surgeons of Canada

Noel Williams, MD Professor Emeritus, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Professor, Department of Internal Medicine, Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada

Noel Williams, MD is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada

Jay A Yelon, DO, FACS Associate Professor of Surgery and Anesthesiology, Program Director, Surgical Critical Care Fellowship, New York Medical College; Chief, Division of Trauma and Surgical Critical Care, Westchester Medical Center

Jay A Yelon, DO, FACS is a member of the following medical societies: American Association for the Surgery of Trauma , American Burn Association , American College of Surgeons , American Trauma Society , Association for Academic Surgery , Eastern Association for the Surgery of Trauma , Pan American Trauma Society , Shock Society , Society of Critical Care Medicine , Southeastern Surgical Congress , and Surgical Infection Society

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Peptic Ulcer Case Study

Nursing 7450 Pathophysiology of Altered Health States

Dr. Amy Mackos, Dr. Kelly Casler, and Dr. Lee Cordell

• Hsiaochi (Chi) Chang
• Stephine Burrows

Our rationale for choosing this condition

We chose Peptic Ulcer disease due to the fact that it’s commonly seen among the patients taking NSAIDs and Aspirin; therefore, we anticipate seeing this condition frequently.

(Picture retrieved from https://www.webmd.com/digestive-disorders/ss/slideshow-visual-guide-to-stomach-ulcers)