Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18

1152 Peptic Ulcer Disease

■Physical findings of malignant ulcer:

➣anemia

➣weight loss

➣abdominal mass

tests

Specific Diagnostic Tests

■Upper GI barium study

■Endoscopy

Indirect Tests

■H. pyloriantibody, urea breath tests, fecal antigen tests

differential diagnosis

■Nonulcer dyspepsia (diagnosis made by negative imaging study)

■Gastroesophageal reflux (diagnosis made by endoscopy, pH study,

response to empirical trial of therapy, etc.)

■Cholelithiasis (diagnosis made by ultrasound or CT imaging)

■Gastroparesis (diagnosis made by nuclear medicine gastric emptying

study)

* Gastric neoplasia (diagnosis made by endoscopy or barium radiogra-

phy)

management

What To Do First

■Should I empirically treat for an ulcer or make a definitive diagnosis

by specific testing?

➣This is a philosophical issue and should be decided in conjunc-

tion with the patient’s needs.

■If I decide to empirically treat, do I use an anti-secretory agent or

anti-Helicobacter pyloritherapy?

➣Both are acceptable approaches, but a response to either therapy

does not exclude nonulcer dyspepsia, GERD or malignancy.

■If I decide to do a diagnostic test, should it beH. pyloritesting or

evaluating for an ulcer with endoscopy or a barium UGI study?

■Endoscopy vs. barium UGI

➣Endoscopy is:

more accurate than an UGI

allows for biopsy to exclude malignancy or diagnoseHelicobac-

ter pylori

can diagnose esophagitis