Abdominal pain, diarrhea, GI bleeding, hepatosplenomegaly and small bowel obstruction are well described presentations. Still gastrointestinal histoplasmosis often results in either vague symptomatology or no symptoms. [uthsc.pure.elsevier.com]

Right: Post-bulbar duodenal stricture in a 61 year-old woman with a history of peptic ulcer disease, who had presented with symptoms suggestive of partial gastric outlet obstruction. [endoatlas.com]

Gastrointestinal tuberculosis presenting as isolated involvement of the duodenum is a rare case. Case Presentation: A 13 year male, presented with features of gastric outlet obstruction. [casereports.bmj.com]

The present case reinforces the requirement for the early recognition and correct treatment of peptic ulcers accompanied with multiple complications. A 67-year-old man presented with recurrent abdominal pain, fever and melena. [spandidos-publications.com]

Presents practical, hands-on advice on selecting and implementing the latest surgical approaches from today’s preeminent general surgeons. [books.google.com]

• Weight Loss

  But the most common cause is significant weight loss leading to loss of mesenteric fat pad in patients with severe debilitating illnesses like malignancy, malabsorption syndromes, burns etc. 3 In postoperative period, it has been seen following gastric [ispub.com]

  Early satiety, unexplained weight loss, loss of appetite, progressive dysphagia, gradually worsening symptoms of gastric outlet obstruction Gastric cancer is another complication in gastric ulcer disease. [medicaljoyworks.com]

  Loss of appetite with persistent bloating or fullness after eating also suggests gastric outlet obstruction. Prolonged vomiting may cause weight loss, dehydration, and alkalosis. [merckmanuals.com]

  Moderate weight loss that may not raise any concern. Late Symptoms As the condition worsens, then additional symptoms may be noticed in addition to the early symptoms. Projectile vomiting. Severe weight loss. Dehydration due to excessive vomiting. [healthhype.com]

  Blind loop syndrome (sometimes called stasis syndrome or stagnant loop syndrome) - this affects digestion and absorption, causing: Bloating, loss of appetite, abdominal pain and nausea. Fatty stools (steatorrhoea). Diarrhoea with weight loss. [patient.info]

• Sepsis

  In countries which have implemented preventive measures against the SGB, recommended by the CDC, cases of neonatal sepsis caused by this organism have decreased but the late neonatal sepsis cases still in their levels. [isglobal.org]

  S agalactiae is now best known as a cause of postpartum infection and as the most common cause of neonatal sepsis. [emedicine.medscape.com]

  Sepsis can be the initial presentation of perforation. [ncbi.nlm.nih.gov]

  Its causes of death were sepsis, respiratory failure and hepatic failure. [happycampus.com]

  Streptococcus agalactiae is the leading cause of bacterial sepsis and mening ... [rcsb.org]

• Noncompliance

  Causes of treatment failure: Use of NSAIDs by the patient, false-negative H pylori test results, noncompliance, or other causes of ulcers. [empendium.com]

• Dyspnea

  This may present either as hematemesis, melena or other features of anaemia (easy fatigability, lethargy, dyspnea). Very rarely profusely bleeding ulcer can be present as hematochezia. [medicaljoyworks.com]

  Case report We present the case of a 22-year-old woman who went to the emergency department of her local hospital with fever, dry cough, epistaxis, prostration and myalgia of eight days’ evolution, together with recent-onset but progressively worsening dyspnea [revportcardiol.org]

  […] meningitis Hematologic malignancy Fever, headache 12,700 25,000 - 1.1 48 9 F 50 Arthritis Chronic renal failure, cancer Arthritis 17,800 567,000 21.2 4.2 17 10 F 56 Arthritis No Arthritis 17,800 207,000 - 0.7 1 11 F 63 Urinary tract Renal stone Fever, dyspnea [ncbi.nlm.nih.gov]

  Specifically, several symptoms (i.e., altered mental state, dyspnea), signs (i.e., tachycardia, tachypnea, reduced pulse pressure, decreased urine output) and laboratory findings (hyperlactatemia, arterial hypoxemia, increased creatinine, coagulation [wjes.biomedcentral.com]

• Vomiting

  Vomiting- The symptoms of peptic ulcers may include vomiting. Vomiting after consumption of food may be caused by an ulcer, food poisoning, or gastritis (inflammation of the stomach lining). [alaskagi.com]

  Vomiting is intermittent, non bilious and occurs one hour after meals containing undigested foods. [medicaljoyworks.com]

  Nausea and Vomiting Obstruction of the duodenum can also cause patients to become nauseated and vomit. [livestrong.com]

  Less often, ulcers may cause severe signs or symptoms such as: Vomiting or vomiting blood — which may appear red or black Dark blood in stools, or stools that are black or tarry Trouble breathing Feeling faint Nausea or vomiting Unexplained weight loss [mayoclinic.org]

  Symptoms can include: repeated episodes of vomiting, with large amounts of vomit that contain undigested food a persistent feeling of bloating or fullness feeling very full after eating less food than usual unexplained weight loss An endoscopy can be [nhs.uk]

• Nausea

  Nausea- The symptoms of peptic ulcers may include nausea. Nausea is a feeling of sickness with an inclination to vomit. Nausea has many possible causes. [alaskagi.com]

  Nausea and Vomiting Obstruction of the duodenum can also cause patients to become nauseated and vomit. [livestrong.com]

  […] vomiting heartburn moody pms or vomiting heartburn moody pms or two and have had the following symptoms: nausea vomiting heartburn Make These 8 Simple Changes for a Healthy Fall Taking any of these may sound utterly strange at first but I was getting [transnationalterrorism.eu]

  Some people may experience nausea, vomiting, constipation, diarrhea, and headaches after taking these. Other side effects may include bruising or bleeding. [medicalnewstoday.com]

  The side effects of these antibiotic are usually mild and include: nausea, vomiting, diarrhoea, and a metallic taste in the mouth. [hse.ie]

• Abdominal Pain

  Abdominal pain, diarrhea, GI bleeding, hepatosplenomegaly and small bowel obstruction are well described presentations. Still gastrointestinal histoplasmosis often results in either vague symptomatology or no symptoms. [uthsc.pure.elsevier.com]

  Following anti-hemorrhagic and antibiotic treatments, the symptoms of fever and abdominal pain were relieved. [spandidos-publications.com]

  Symptoms of Peptic Ulcer Disesase Symptoms include: Upper abdominal pain Pain on hunger Pain at night Pain relieved by food Nausea, loss of appetite, fullness after eating can occur. [singhealth.com.sg]

  In patients in whom abdominal pain is the major clinical symptom, difficulties related to the characterization of pain and to the high prevalence of functional abdominal pain may delay the diagnosis. [scielo.br]

  Gastric ulcers cause abdominal pain which aggravate with meals. So this goes as a cycle leading to increase morbidity. [medicaljoyworks.com]

• Epigastric Pain

  Burning epigastric pain or epigastric cramps between meals, that wake the patient at night. Recurrent episodes characteristically last a few days and are often accompanied by nausea and even vomiting. [medicalguidelines.msf.org]

  […] develops 1-3h after meal hunger pain and central back pain pain is relieved by eating or anatacids nausea and epigastric pain (gnawing burning sensation) periods of pain over weeks and then periods of remission treatment of duodenal ulcer medical surgical [quizlet.com]

  Other factors responsible for disease includes eating too much spicy and fatty food, stress, drinking alcohol and coffee.2 Symptoms of peptic ulcer include epigastric pain, heartburn, nocturnal pain, nausea, postprandial pain, weight loss due to decreased [medcraveonline.com]

  CASE REPORT A 31 year old male was admitted to our institution with a 1 year history of recurrent epigastric pain and an acute episode of vomiting. Epigastric pain was characterized as intermittent, mild and gnawing in character. [wjgnet.com]

  The average duration was 3.3 years. 7) The main symptom presented were epigastric pain (95.6%) in perforation and melena or hematemesis in bleeding (90%). 8) The physical examination in perforation revealed epigastric or right upper quadrant tenderness [happycampus.com]

• Recurrent Vomiting

  Case Reports Case 1 A 50-year-old female presented with history of epigastric pain, recurrent vomiting and significant weight loss since 4 months. [jdeonline.in]

  Recurrent vomiting, bloating sensation after meal, early satiety, weight loss Gastric outlet obstruction following gastric ulcer( due to fibrosis during healing) may present with those symptoms. [medicaljoyworks.com]

  Individuals with gastric outlet obstruction will often have recurrent vomiting of food that has accumulated in the stomach, but which cannot pass into the small intestine due to the obstruction. [en.wikipedia.org]

  vomiting, or a family history of GI cancer. [clinicaladvisor.com]

  Recent sustained weight loss, progressive dysphagia or odynophagia, recurrent vomiting – with or without pain – should raise the suspicion of an outlet obstruction from a duodenal ulcer. [cancertherapyadvisor.com]

• Osteoporosis

  Additional medications that may increase your risk for gastric, duodenal, and bleeding ulcers include: osteoporosis treatments such as alendronate (Fosamax) and risedronate (Actonel) anticoagulants, like warfarin (Coumadin) or clopidogrel (Plavix) selective [healthline.com]

  Incisional hernias Osteoporosis Total or partial gastrectomy may result in faulty absorption of essential food stuffs such as vitamins and mineral salts. Carcinoma of the stomach (in association with H. [veterans.gc.ca]

  Although they may promote loss of bone (osteoporosis) and low magnesium levels, both side effects are easily identified and treated. [medicinenet.com]

• Muscle Spasm

  Side effects may include tiredness, depression, sleepiness, anxiety, and muscle spasms. Antibiotics: If H. pylori is causing peptic ulcers that result in indigestion, an antibiotic will be prescribed. [medicalnewstoday.com]

• Withdrawn

  […] first-line triple-regimen therapy failed.[14] After H. pylori is eradicated, there is low risk of recurrent ulcer bleeding when NSAIDs are resumed.[14] NSAIDs induced ulcers[edit] NSAID-associated ulcers heal in 6 to 8 weeks provided the NSAIDs are withdrawn [en.wikipedia.org]

  All anti-inflammatory and antiplatelet drug treatments should be withdrawn. Any long-term anticoagulation should be temporarily reversed. Assessment and treatment of HP infection, if present, seems reasonable. [jamanetwork.com]

• Irritability

  Jordan が「過敏性大腸 irritable colon」として報告した。 Henry Bockus （1894〜1982，元ペンシルバニア大学消化器科教授）の消化器病学の教科書でirritable colonが大々的に取り上げられた。 [shiga-med.ac.jp]

  Pain comes from the ulcer itself when gastric acid contact with it and irritate it. Duration of pain will be varies from few minutes to few hours and usually during the daytime. [medicaljoyworks.com]

  This is a condition in which stomach acids leak back up into the esophagus and irritate the sensitive lining of the stomach, known as the mucosa. The irritation can scar the esophagus, which then becomes narrow and constricted. [medicalnewstoday.com]

  These medicines irritate the lining of the stomach and upper intestine, making it easier for stomach acid to damage the lining. Your stomach makes too much acid. [summitmedicalgroup.com]

  Alcohol can irritate and erode the mucous lining of your stomach, and it increases the amount of stomach acid that's produced. Have untreated stress. Eat spicy foods. [mayoclinic.org]

• Seizure

  The most frequently registered are diarrhea, rash and candidiasis (amoxicillin); nausea, metallic taste, peripheral neuropathy and antabus-like effect with alcohol intake (metronidazole); prolongation of QT interval and seizures can appears in predisposed [elynsgroup.com]

You might have to undergo a more extensive medical workup looking for unusual underlying causes for peptic ulcer disease. [verywell.com]

As part of the initial workup, exclude the possibility of functional nonmechanical causes of obstruction, such as diabetic gastroparesis. [emedicine.medscape.com]

WORKUP Laboratory Studies • Obtain a CBC. Check the hemoglobin and hematocrit to. rule out the possibility of anemia. • Obtain an electrolyte panel. [slideshare.net]

• Pneumoperitoneum

  Ultrasound (US) has also been studied and shows excellent potential for identifying pneumoperitoneum. The most useful imaging modality is CT scan that is highly sensitive and specific for free air. [ncbi.nlm.nih.gov]

  Referred pain to the shoulder Diagnosis Abdominal x-ray : free intraperitoneal air ( pneumoperitoneum ) under the diaphragm (if upright) or between liver and lateral abdominal wall (if lateral) Abdominal CT with water-soluble contrast (most sensitive) [amboss.com]

  If perforation is suspected (in a patient with severe diffuse abdominal pain and peritoneal signs on exam), evidence of pneumoperitoneum should be sought with an upright chest or abdominal X-rays; if these are negative and suspicion is still high, a CT [clinicaladvisor.com]

  Around 70% of cases, present visible pneumoperitoneum at plain radiologic abdomen. [elynsgroup.com]

• Fibrinoid Necrosis

  During the active phase, the base of the ulcer shows 4 zones: fibrinoid necrosis, inflammatory exudate, granulation tissue and fibrous tissue. [en.wikipedia.org]

  Four histological zones are described surrounding chronic peptic ulcer – Superficial layer of fibrin and exudates with successive underlying zones of fibrinoid necrosis, granulation tissue and fibrosis.7 B. [jebmh.com]

Possible treatments for this disease include conservative treatment with drugs, endoscopic sphincterotomy and surgical therapy. The choice is based on the etiology, the severity of the disease and the patient's general condition. [spandidos-publications.com]

Surgical treatment The choice of surgical treatment depends on the size and localization of the perforation, the viability of the duodenal walls, the degree of local contamination and underlying etiology. [tandfonline.com]

In severe or recurrent cases, dose can be increased to 40 mg once daily and the treatment can be prolonged for up to 8 weeks. – If the patient has frequent recurrences, unrelated to NSAID use, that require repeated treatment with antiulcer drugs: see [medicalguidelines.msf.org]

Surgical Treatment Surgical treatment does not eliminate the risk of ulcer recurrence and is associated with late complications. [empendium.com]

All three antibiotics can make oral contraception ('the pill') work less effectively so you should use an alternative method of contraception during treatment and for seven days after treatment. [hse.ie]

Prognosis A functioning and unrestricted intestine is a prerequisite for living independent of the most advanced and continuous medical care available. Achieving this desirable goal is the rule with surgery for duodenal obstructions of all types. [medical-dictionary.thefreedictionary.com]

Prognosis Over the past 3 decades, the prognosis of patients with gastric perforation has improved. But delays in diagnosis and treatment can lead to death. [ncbi.nlm.nih.gov]

Prognosis Prognosis will depend on the type and extent of the obstruction, the infant's age at diagnosis, the infant's overall condition, and the presence and severity of any other congenital anomalies. [encyclopedia.com]

In the rare cases when surgery cannot be done, prognosis is poor. Obstruction may be caused by scarring, spasm, or inflammation from an ulcer. [merckmanuals.com]

The choice is based on the etiology, the severity of the disease and the patient's general condition. [spandidos-publications.com]

Etiology Risk factors Chronic gastritis caused by H. pylori, a curved, flagellated gram-negative rod Duodenal ulcers : up to 90% are due to H. pylori infection Gastric ulcers : up to 80% are due to H. pylori infection Chronic gastritis of other etiology [amboss.com]

Pathology Etiology Gastric outlet obstruction can be due to malignant or benign causes. [radiopaedia.org]

The incidence of GOO in patients with peripancreatic malignancy, the most common malignant etiology, has been reported between 15- 20%. [tropicalgastro.com]

Etiology of PUD However, we must remember that approximately 5-15% of patients considered Hp negative, despite performing wide comprehensive etiological studies, do not get to find again the precise cause of PU, which are referred to as "idiopathic”. [elynsgroup.com]

(An excellent review of the epidemiology of GBS disease prior to the publication of prevention guidelines for neonatal GBS disease) Schuchat, A. “Epidemiology of group B streptococcal disease in the United States: shifting paradigms”. [infectiousdiseaseadvisor.com]

Reference article This is a summary article; read more in our article on peptic ulcer disease. anatomy stomach epidemiology older population with M:F ratio of 3:1 main risk factors H. pylori NSAID and corticosteroid use severe physical stress presentation [radiopaedia.org]

To critically review the evidence on epidemiology, diagnostic management, and available treatments for PUD in the pediatric age. Methods. [hindawi.com]

Capsular polysaccharide typing is significant and essential for epidemiological studies of GBS. [archcid.com]

Approaches each topic using the same easy-to-follow format : disease presentation, pathophysiology, and diagnostics, followed by surgical therapy. Discusses which approach to take, how to avoid or minimize complications, and what outcomes to expect. [books.google.com]

[…] main risk factors H. pylori NSAID and corticosteroid use severe physical stress presentation dyspeptic symptoms haemorrhage (14%) incidental (faecal-occult blood) acute (melaena, haematemesis, or both) perforation (6%) gastric-outlet obstruction (rare) pathophysiology [radiopaedia.org]

Delayed gastric emptying, increased intragastric pH, and reflux of the duodenal contents into the stomach are factors indicative of the pathophysiology of gastric candidiasis after gastric surgery. [dbpia.co.kr]

Pathophysiology Intrinsic or extrinsic obstruction of the pyloric channel or duodenum is the usual pathophysiology of GOO; the mechanism of obstruction depends upon the underlying etiology. [emedicine.medscape.com]

[…] ulcer bleeding secondary to NSAID use; however, no clinical data is available that proves that this strategy prevents ulcer complication No study has evaluated the efficacy of H2RAs in chronic NSAID users Less effective than proton pump inhibitors (PPIs [specialty.mims.com]

The use of intrapartum antibiotics for selective high-risk patients, while being sufficient for the prevention of early onset GBS disease, has been found to be insufficient for prevention of late onset GBS disease. [hindawi.com]

The data will be important in the detection, prevention, treatment and vaccination against this microorganism. Project Code PI13/00127 [isglobal.org]

It can have potentially serious complications such as bleeding or perforation, with a high risk of mortality.1 Optimal treatment with proton pump inhibitors (PPIs) facilitates healing and can prevent complications and recurrence. [bmj.com]

If you have peptic ulcer, all the preventive advices can help limit the severity of the disease. In addition, it is also advisable to have small but frequent meals instead of one large meal, and to avoid fatty and spicy food. [chp.gov.hk]