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Return to: Twitter Facebook Linkedin Reddit Get Citation Citation AMA Citation Gastric Ulcer. In: Doherty GM. Doherty G.M. Ed. Gerard M. Doherty.eds. Quick Answers Surgery New York, NY: McGraw-Hill; 2010. http://accesssurgery.mhmedical.com/content.aspx?bookid=853§ionid=49662099. Accessed June 22, 2017. MLA Citation . "Gastric Ulcer." Quick Answers Surgery Doherty GM. Doherty G.M. Ed. Gerard M. Doherty. New York, NY: McGraw-Hill, 2010, http://accesssurgery.mhmedical.com/content.aspx?bookid=853§ionid=49662099. Download citation file: RIS (Zotero) EndNote BibTex Medlars ProCite RefWorks Reference Manager © Copyright Tools Search Book Top Return Clip Gastric Ulcer + Essential Features Print Section + • Epigastric pain• Ulcer demonstrated by endoscopy or radiography• Acid present on gastric analysis ++ Epidemiology + • Peak incidence at 40-60 years old• 85-90% of patients infected with Helicobacter pylori• Type I ulcers (50%)-Located within 2 cm of the incisura angularis-Gastric acid output is normal or low• Type II ulcers (20%)-Both ulceration of gastric body and duodenum-Increased acid secretion• Type III ulcers (20%)-Prepyloric location-Increased acid secretion• Type IV ulcers (5-10%)-Located high on lesser curvature at or near gastroesophageal junction-Gastric acid output is normal or low• Type V ulcers (< 5%)-Results from NSAID use + Clinical Findings Print Section ++ Symptoms and Signs + • Principal symptom is epigastric pain relieved by food or antacids• Vomiting, anorexia, and aggravation of pain by eating are also common• Epigastric tenderness may be present ++ Laboratory Findings + • Evaluation for H pylori infection ++ Imaging Findings + • Radiographic or endoscopic evidence of gastric ulceration + Diagnostic Considerations Print Section + • Signs and symptoms of gastric ulcer should prompt contrast radiography or upper endoscopy for diagnosis ++ Rule Out + • Ulcerated malignancy-Obtain multiple biopsies from edge of the lesion-Rolled-up ulcer margins-More common with larger ulcers (> 2 cm)• Zollinger-Ellison syndrome if disease is severe and refractory or if associated with more distal ulceration + Work-up Print Section + • Signs and symptoms of gastric ulcer• Radiographic or endocopic findings consistent with gastric ulcer• Biopsy to exclude malignancy• Testing for H pylori ++ When to Admit + • Complications of gastric ulcer (bleeding, perforation, high-grade obstruction, severe pain) + Treatment and Management Print Section + • Types I, IV, and V gastric ulcers represent defects in mucosal protection• Types II and III gastric ulcers are associated with acid hypersecretion and behave similar to duodenal ulcers ++ Surgery + • Parietal cell vagotomy• Truncal vagotomy and antrectomy• Vagotomy and pyloroplasty ++ Indications + • Intractibility: Excision of ulcer and acid reduction• Perforation, bleeding, obstruction ++ Medications + • Treatment of H pylori• Antacids• H2 receptor blockers• Proton pump inhibitors ++ Treatment Monitoring + • Repeat endoscopy after 4-16 weeks to document healing ++ Complications + • Perforation• Obstruction• Bleeding ++ Prognosis + • < 5% recurrence after vagotomy and antrectomy• 10-12% recurrence after parietal cell or truncal vagotomy and pyloroplasty ++ Prevention + • Avoidance of NSAIDs + Resources Print Section ++ References ++Calam J, Baron JH. ABC of the upper gastrointestinal tract: pathophysiology of duodenal and gastric ulcer and gastric cancer. BMJ. 2001;323:980. [PubMed: 11679389] ++Schubert ML. Peura DA. Control of gastric acid secretion in health and disease. Gastroenterology 2008;134:1842. [PubMed: 18474247] ++Jamieson GG: Current status of indications for surgery in peptic ulcer disease. World J Surg 2000;24:256. [PubMed: 10658057] ++Logan RP, Walker MM: ABC of the upper gastrointestinal tract: epidemiology and diagnosis of Helicobacter pylori infection. BMJ 2001;323:920. [PubMed: 11668141] ++Leontiadis GI et al: Systematic reviews of the clinical effectiveness and cost-effectiveness of proton pump inhibitors in acute upper gastrointestinal bleeding. Health Technol Assess 2007;11:iii, 1.