K28.4

Clinical Causes: Use of nonsteroidal anti-inflammatory drugs (NSAIDs) Helicobacter pylori infection Post-surgical changes from gastric or bariatric surgeries Excess stomach acid production Smoking and alcohol use Stress and severe medical illnesses Certain medications that impair the stomach lining

Key Symptoms: Gastrointestinal bleeding evidenced by vomiting blood (hematemesis) Dark or tarry stools (melena) Abdominal pain or discomfort, often burning or gnawing Nausea and vomiting Unexplained fatigue or weakness from blood loss Bloating or feeling of fullness Loss of appetite

Diagnosis Path: Diagnosis involves a combination of medical history, physical examination, and diagnostic tests. Upper endoscopy (gastroscopy) is the primary procedure used to visualize the ulcer directly, assess bleeding, and obtain biopsies if needed. Additional tests, such as blood work to evaluate anemia or infection, can aid in comprehensive assessment. Imaging studies might be used in certain cases but are less definitive than endoscopy for this condition.

Treatment Protocols: Treatment strategies aim to promote healing, control bleeding, and prevent recurrence. Common approaches include: - **Medications:** Proton pump inhibitors (PPIs) to reduce stomach acid, antibiotics if H. pylori infection is present, and medications to protect the stomach lining. - **Endoscopic interventions:** For active bleeding, techniques such as clipping, cauterization, or injection therapy can be used during endoscopy. - **Blood transfusions:** Required in cases of significant blood loss. - **Lifestyle modifications:** Avoiding NSAIDs, reducing alcohol intake, quitting smoking, and managing stress. - **Follow-up care:** Regular monitoring to ensure healing and detect potential complications early. Surgical intervention is rare but may be necessary if bleeding cannot be controlled or if complications like perforation occur.