Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

GERD and Peptic Ulcer Disease

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In one line

·GERD and peptic ulcer disease happen when stomach acid ends up in the wrong place — either splashing up into the esophagus (the food tube) or eating a hole in the stomach or duodenum (the first part of the small intestine).

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Normal physiology

·The lower esophageal sphincter (LES) — a ring of smooth muscle at the bottom of the esophagus — stays closed between swallows to keep stomach acid from splashing up. Meanwhile, the stomach and duodenum coat themselves in a thick layer of mucus and bicarbonate (a base that neutralizes acid) so their own acid does not burn through. Keep that picture in your head, because every weird finding is just a change from this normal setup.

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What goes wrong

·GERD happens when the lower esophageal sphincter (LES) becomes weak or a hiatal hernia pulls it open, so acid splashes up into the esophagus. Peptic ulcer disease happens when H. pylori bacteria burrow into the stomach lining and weaken the mucus shield, or when NSAIDs (nonsteroidal anti-inflammatory drugs like ibuprofen, naproxen, or aspirin) block the chemicals that build mucus, leaving the lining naked against acid. Either way, acid ends up touching tissue that cannot handle it.

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Hallmark signs

·Burning feeling behind the breastbone (heartburn) that often comes after eating or when lying down
·Sour or bitter taste in the mouth (acid regurgitation)
·Pain in the upper middle belly (epigastric pain), often a gnawing or burning feeling that comes and goes with meals
·Feeling uncomfortably full or bloated after eating even a small amount of food
·Nausea or throwing up
·Chronic cough or hoarse voice that won't go away
·Trouble swallowing or food feeling stuck in the chest (dysphagia)
·Unintended weight loss (losing pounds without trying to diet or exercise more)

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Red flags · escalate now

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Workup

·Upper endoscopy (esophagogastroduodenoscopy, EGD)
·Helicobacter pylori testing — urea breath test, stool antigen test, or rapid urease test on biopsy during endoscopy
·Complete blood count (CBC)
·Fecal occult blood test (FOBT) or fecal immunochemical test (FIT)
·Serum gastrin level (if refractory or atypical ulcers)
·Esophageal pH monitoring (24-hour ambulatory or wireless capsule)
·Barium swallow (esophagram) with fluoroscopy

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Treatment

·Proton pump inhibitor (PPI) — omeprazole 20–40 mg once daily or equivalent — for 8 weeks in GERD, 4–8 weeks in peptic ulcer disease
·H. pylori eradication therapy — standard triple therapy (PPI + clarithromycin 500 mg + amoxicillin 1 g, all twice daily for 14 days) or quadruple therapy (PPI + bismuth + tetracycline + metronidazole for 10–14 days) if resistance is likely
·Stop NSAIDs (ibuprofen, naproxen, aspirin at high dose) or switch to acetaminophen; if NSAIDs must continue, add PPI daily for protection
·Lifestyle changes — lose weight if overweight, raise the head of the bed 6–8 inches, avoid meals within 3 hours of bedtime, stop smoking, limit alcohol, caffeine, chocolate, and fatty foods
·Surgical fundoplication (Nissen or partial wrap) or LINX magnetic sphincter augmentation (for GERD refractory to medical therapy)
·Urgent upper endoscopy (EGD) if alarm features are present — new trouble swallowing (dysphagia), unintended weight loss > 5%, gastrointestinal bleeding, iron-deficiency anemia, persistent vomiting, age > 60 with new-onset symptoms, family history of upper GI cancer

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NCLEX trap

·GERD and peptic ulcer disease need you to find the upstream cause: Is the lower esophageal sphincter weak? Is there a hiatal hernia (part of the stomach pushing up through the diaphragm)? Does the patient have H. pylori infection? Are they taking NSAIDs like ibuprofen? Treat the cause, not just the pain.
·Always ask: Does it come after eating? Does it get worse lying flat? Does it go away with antacids? GERD is much more common than heart attack. Answer these questions first or you will chase the wrong problem.
·H. pylori must be killed with triple or quadruple therapy: a proton pump inhibitor plus two or three antibiotics for 10 to 14 days. A PPI alone will hide symptoms but will not kill the bacteria. The ulcer will come back.
·Red flags demand endoscopy (a camera scope down the throat to look inside): trouble swallowing, weight loss, bleeding, anemia, or new symptoms starting after age 60. GERD that does not respond to a PPI also requires endoscopy. Do not delay.
·Always ask: Do you take any over-the-counter pain medicine? Aspirin? Ibuprofen? NSAIDs block prostaglandins (the body's chemicals that protect the stomach lining by making mucus and increasing blood flow). If the patient needs NSAIDs, add a PPI or switch to acetaminophen.
·Lifestyle changes alone are rarely enough. Most patients with GERD need a PPI. Lifestyle changes support medicine; they do not replace it in moderate-to-severe GERD or peptic ulcer disease.

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