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class="vector-toc-link" href="#H._pylori"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.1</span> <span><i>H. pylori</i></span> </div> </a> <ul id="toc-H._pylori-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-NSAIDs" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#NSAIDs"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.2</span> <span>NSAIDs</span> </div> </a> <ul id="toc-NSAIDs-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Stress" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Stress"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.3</span> <span>Stress</span> </div> </a> <ul id="toc-Stress-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Diet" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Diet"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.4</span> <span>Diet</span> </div> </a> <ul id="toc-Diet-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Other" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Other"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.5</span> <span>Other</span> </div> </a> <ul id="toc-Other-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Diagnosis" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Diagnosis"> <div class="vector-toc-text"> <span class="vector-toc-numb">3</span> <span>Diagnosis</span> </div> </a> <button aria-controls="toc-Diagnosis-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Diagnosis subsection</span> </button> <ul id="toc-Diagnosis-sublist" class="vector-toc-list"> <li id="toc-Classification" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Classification"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.1</span> <span>Classification</span> </div> </a> <ul id="toc-Classification-sublist" class="vector-toc-list"> <li id="toc-By_location" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#By_location"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.1.1</span> <span>By location</span> </div> </a> <ul id="toc-By_location-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Modified_Johnson" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Modified_Johnson"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.1.2</span> <span>Modified Johnson</span> </div> </a> <ul id="toc-Modified_Johnson-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Macroscopic_appearance" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Macroscopic_appearance"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.2</span> <span>Macroscopic appearance</span> </div> </a> <ul id="toc-Macroscopic_appearance-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Microscopic_appearance" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Microscopic_appearance"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.3</span> <span>Microscopic appearance</span> </div> </a> <ul id="toc-Microscopic_appearance-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Differential_diagnosis" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Differential_diagnosis"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.4</span> <span>Differential diagnosis</span> </div> </a> <ul id="toc-Differential_diagnosis-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Prevention" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Prevention"> <div class="vector-toc-text"> <span class="vector-toc-numb">4</span> <span>Prevention</span> </div> </a> <ul id="toc-Prevention-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Management" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Management"> <div class="vector-toc-text"> <span class="vector-toc-numb">5</span> <span>Management</span> </div> </a> <button aria-controls="toc-Management-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Management subsection</span> </button> <ul id="toc-Management-sublist" class="vector-toc-list"> <li id="toc-Eradication_therapy" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Eradication_therapy"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.1</span> <span>Eradication therapy</span> </div> </a> <ul id="toc-Eradication_therapy-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-NSAIDs-induced_ulcers" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#NSAIDs-induced_ulcers"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.2</span> <span>NSAIDs-induced ulcers</span> </div> </a> <ul id="toc-NSAIDs-induced_ulcers-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Bleeding" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Bleeding"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.3</span> <span>Bleeding</span> </div> </a> <ul id="toc-Bleeding-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Anticoagulants" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Anticoagulants"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.4</span> <span>Anticoagulants</span> </div> </a> <ul id="toc-Anticoagulants-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Epidemiology" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Epidemiology"> <div class="vector-toc-text"> <span class="vector-toc-numb">6</span> <span>Epidemiology</span> </div> </a> <ul id="toc-Epidemiology-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-History" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#History"> <div class="vector-toc-text"> <span class="vector-toc-numb">7</span> <span>History</span> </div> </a> <ul id="toc-History-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Notes" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Notes"> <div class="vector-toc-text"> <span class="vector-toc-numb">8</span> <span>Notes</span> </div> </a> <ul id="toc-Notes-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> <span class="vector-toc-numb">9</span> <span>References</span> </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> <span class="vector-toc-numb">10</span> <span>External links</span> </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" title="Table of Contents" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-vector-page-titlebar-toc" class="vector-dropdown-checkbox " aria-label="Toggle the table of contents" > <label id="vector-page-titlebar-toc-label" for="vector-page-titlebar-toc-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--icon-only " aria-hidden="true" ><span class="vector-icon mw-ui-icon-listBullet mw-ui-icon-wikimedia-listBullet"></span> <span class="vector-dropdown-label-text">Toggle the table of contents</span> </label> <div class="vector-dropdown-content"> <div id="vector-page-titlebar-toc-unpinned-container" class="vector-unpinned-container"> </div> </div> </div> </nav> <h1 id="firstHeading" class="firstHeading mw-first-heading"><span class="mw-page-title-main">Peptic ulcer disease</span></h1> <div id="p-lang-btn" class="vector-dropdown mw-portlet mw-portlet-lang" > <input type="checkbox" id="p-lang-btn-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-p-lang-btn" class="vector-dropdown-checkbox mw-interlanguage-selector" aria-label="Go to an article in another language. Available in 71 languages" > <label id="p-lang-btn-label" for="p-lang-btn-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--action-progressive mw-portlet-lang-heading-71" aria-hidden="true" ><span class="vector-icon mw-ui-icon-language-progressive mw-ui-icon-wikimedia-language-progressive"></span> <span class="vector-dropdown-label-text">71 languages</span> </label> <div class="vector-dropdown-content"> <div class="vector-menu-content"> <ul class="vector-menu-content-list"> <li class="interlanguage-link interwiki-af mw-list-item"><a href="https://af.wikipedia.org/wiki/Maagsweer" title="Maagsweer – Afrikaans" lang="af" hreflang="af" data-title="Maagsweer" data-language-autonym="Afrikaans" data-language-local-name="Afrikaans" class="interlanguage-link-target"><span>Afrikaans</span></a></li><li class="interlanguage-link interwiki-ar mw-list-item"><a href="https://ar.wikipedia.org/wiki/%D9%82%D8%B1%D8%AD%D8%A9_%D9%87%D8%B6%D9%85%D9%8A%D8%A9" title="قرحة هضمية – Arabic" lang="ar" hreflang="ar" data-title="قرحة هضمية" data-language-autonym="العربية" data-language-local-name="Arabic" class="interlanguage-link-target"><span>العربية</span></a></li><li class="interlanguage-link interwiki-hyw mw-list-item"><a href="https://hyw.wikipedia.org/wiki/%D5%8D%D5%BF%D5%A1%D5%B4%D5%B8%D6%84%D5%BD%D5%AB_%D4%BD%D5%B8%D6%81" title="Ստամոքսի Խոց – Western Armenian" lang="hyw" hreflang="hyw" data-title="Ստամոքսի Խոց" data-language-autonym="Արեւմտահայերէն" data-language-local-name="Western Armenian" class="interlanguage-link-target"><span>Արեւմտահայերէն</span></a></li><li class="interlanguage-link interwiki-az mw-list-item"><a href="https://az.wikipedia.org/wiki/M%C9%99d%C9%99_xoras%C4%B1" title="Mədə xorası – Azerbaijani" lang="az" hreflang="az" data-title="Mədə xorası" data-language-autonym="Azərbaycanca" data-language-local-name="Azerbaijani" class="interlanguage-link-target"><span>Azərbaycanca</span></a></li><li class="interlanguage-link interwiki-azb mw-list-item"><a href="https://azb.wikipedia.org/wiki/%D9%85%D8%B9%D8%AF%D9%87_%D8%AE%D9%88%D8%B1%D8%A7%D8%B3%DB%8C" title="معده خوراسی – South Azerbaijani" lang="azb" hreflang="azb" data-title="معده خوراسی" data-language-autonym="تۆرکجه" data-language-local-name="South Azerbaijani" class="interlanguage-link-target"><span>تۆرکجه</span></a></li><li class="interlanguage-link interwiki-bn mw-list-item"><a href="https://bn.wikipedia.org/wiki/%E0%A6%AA%E0%A7%87%E0%A6%AA%E0%A6%9F%E0%A6%BF%E0%A6%95_%E0%A6%86%E0%A6%B2%E0%A6%B8%E0%A6%BE%E0%A6%B0" title="পেপটিক আলসার – Bangla" lang="bn" hreflang="bn" data-title="পেপটিক আলসার" data-language-autonym="বাংলা" data-language-local-name="Bangla" class="interlanguage-link-target"><span>বাংলা</span></a></li><li class="interlanguage-link interwiki-be-x-old mw-list-item"><a href="https://be-tarask.wikipedia.org/wiki/%D0%AF%D0%B7%D0%B2%D0%B0%D0%B2%D0%B0%D1%8F_%D1%85%D0%B2%D0%B0%D1%80%D0%BE%D0%B1%D0%B0" title="Язвавая хвароба – Belarusian (Taraškievica orthography)" lang="be-tarask" hreflang="be-tarask" data-title="Язвавая хвароба" data-language-autonym="Беларуская (тарашкевіца)" data-language-local-name="Belarusian (Taraškievica orthography)" class="interlanguage-link-target"><span>Беларуская (тарашкевіца)</span></a></li><li class="interlanguage-link interwiki-bg mw-list-item"><a href="https://bg.wikipedia.org/wiki/%D0%AF%D0%B7%D0%B2%D0%B0" title="Язва – Bulgarian" lang="bg" hreflang="bg" data-title="Язва" data-language-autonym="Български" data-language-local-name="Bulgarian" class="interlanguage-link-target"><span>Български</span></a></li><li class="interlanguage-link interwiki-bs mw-list-item"><a href="https://bs.wikipedia.org/wiki/Pepti%C4%8Dni_ulkus" title="Peptični ulkus – Bosnian" lang="bs" hreflang="bs" data-title="Peptični ulkus" data-language-autonym="Bosanski" data-language-local-name="Bosnian" class="interlanguage-link-target"><span>Bosanski</span></a></li><li class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/%C3%9Alcera_p%C3%A8ptica" title="Úlcera pèptica – Catalan" lang="ca" hreflang="ca" data-title="Úlcera pèptica" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target"><span>Català</span></a></li><li class="interlanguage-link interwiki-cv mw-list-item"><a href="https://cv.wikipedia.org/wiki/%D0%A5%D1%8B%D1%80%C4%83%D0%BC%D0%BB%C4%83%D1%85_%C3%A7%C4%95%D1%80%D0%BD%D0%B8" title="Хырăмлăх çĕрни – Chuvash" lang="cv" hreflang="cv" data-title="Хырăмлăх çĕрни" data-language-autonym="Чӑвашла" data-language-local-name="Chuvash" class="interlanguage-link-target"><span>Чӑвашла</span></a></li><li class="interlanguage-link interwiki-cs mw-list-item"><a href="https://cs.wikipedia.org/wiki/%C5%BDalude%C4%8Dn%C3%AD_v%C5%99ed" title="Žaludeční vřed – Czech" lang="cs" hreflang="cs" data-title="Žaludeční vřed" data-language-autonym="Čeština" data-language-local-name="Czech" class="interlanguage-link-target"><span>Čeština</span></a></li><li class="interlanguage-link interwiki-da mw-list-item"><a href="https://da.wikipedia.org/wiki/Maves%C3%A5r" title="Mavesår – Danish" lang="da" hreflang="da" data-title="Mavesår" data-language-autonym="Dansk" data-language-local-name="Danish" class="interlanguage-link-target"><span>Dansk</span></a></li><li class="interlanguage-link interwiki-se mw-list-item"><a href="https://se.wikipedia.org/wiki/%C4%8Coavjeh%C3%A1vvi" title="Čoavjehávvi – Northern Sami" lang="se" hreflang="se" data-title="Čoavjehávvi" data-language-autonym="Davvisámegiella" data-language-local-name="Northern Sami" class="interlanguage-link-target"><span>Davvisámegiella</span></a></li><li class="interlanguage-link interwiki-de mw-list-item"><a href="https://de.wikipedia.org/wiki/Magengeschw%C3%BCr" title="Magengeschwür – German" lang="de" hreflang="de" data-title="Magengeschwür" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target"><span>Deutsch</span></a></li><li class="interlanguage-link interwiki-dv mw-list-item"><a href="https://dv.wikipedia.org/wiki/%DE%8E%DE%AE%DE%80%DE%AE%DE%83%DE%AA%DE%8E%DE%AC_%DE%8A%DE%A7%DE%83%DE%AA" title="ގޮހޮރުގެ ފާރު – Divehi" lang="dv" hreflang="dv" data-title="ގޮހޮރުގެ ފާރު" data-language-autonym="ދިވެހިބަސް" data-language-local-name="Divehi" class="interlanguage-link-target"><span>ދިވެހިބަސް</span></a></li><li class="interlanguage-link interwiki-el mw-list-item"><a href="https://el.wikipedia.org/wiki/%CE%88%CE%BB%CE%BA%CE%BF%CF%82" title="Έλκος – Greek" lang="el" hreflang="el" data-title="Έλκος" data-language-autonym="Ελληνικά" data-language-local-name="Greek" class="interlanguage-link-target"><span>Ελληνικά</span></a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/%C3%9Alcera_p%C3%A9ptica" title="Úlcera péptica – Spanish" lang="es" hreflang="es" data-title="Úlcera péptica" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target"><span>Español</span></a></li><li class="interlanguage-link interwiki-eu mw-list-item"><a href="https://eu.wikipedia.org/wiki/Ultzera_peptiko" title="Ultzera peptiko – Basque" lang="eu" hreflang="eu" data-title="Ultzera peptiko" data-language-autonym="Euskara" data-language-local-name="Basque" class="interlanguage-link-target"><span>Euskara</span></a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%D8%B2%D8%AE%D9%85_%DA%AF%D9%88%D8%A7%D8%B1%D8%B4%DB%8C" title="زخم گوارشی – Persian" lang="fa" hreflang="fa" data-title="زخم گوارشی" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target"><span>فارسی</span></a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/Ulc%C3%A8re_gastroduod%C3%A9nal" title="Ulcère gastroduodénal – French" lang="fr" hreflang="fr" data-title="Ulcère gastroduodénal" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target"><span>Français</span></a></li><li class="interlanguage-link interwiki-ga mw-list-item"><a href="https://ga.wikipedia.org/wiki/Othras_peipteach" title="Othras peipteach – Irish" lang="ga" hreflang="ga" data-title="Othras peipteach" data-language-autonym="Gaeilge" data-language-local-name="Irish" class="interlanguage-link-target"><span>Gaeilge</span></a></li><li class="interlanguage-link interwiki-ko mw-list-item"><a href="https://ko.wikipedia.org/wiki/%EC%86%8C%ED%99%94%EC%84%B1%EA%B6%A4%EC%96%91" title="소화성궤양 – Korean" lang="ko" hreflang="ko" data-title="소화성궤양" data-language-autonym="한국어" data-language-local-name="Korean" class="interlanguage-link-target"><span>한국어</span></a></li><li class="interlanguage-link interwiki-hy mw-list-item"><a href="https://hy.wikipedia.org/wiki/%D5%8A%D5%A5%D5%BA%D5%BF%D5%AB%D5%AF_%D5%AD%D5%B8%D6%81" title="Պեպտիկ խոց – Armenian" lang="hy" hreflang="hy" data-title="Պեպտիկ խոց" data-language-autonym="Հայերեն" data-language-local-name="Armenian" class="interlanguage-link-target"><span>Հայերեն</span></a></li><li class="interlanguage-link interwiki-hi mw-list-item"><a href="https://hi.wikipedia.org/wiki/%E0%A4%AA%E0%A5%88%E0%A4%AA%E0%A5%8D%E0%A4%9F%E0%A4%BF%E0%A4%95_%E0%A4%85%E0%A4%B2%E0%A5%8D%E0%A4%B8%E0%A4%B0" title="पैप्टिक अल्सर – Hindi" lang="hi" hreflang="hi" data-title="पैप्टिक अल्सर" data-language-autonym="हिन्दी" data-language-local-name="Hindi" class="interlanguage-link-target"><span>हिन्दी</span></a></li><li class="interlanguage-link interwiki-hr mw-list-item"><a href="https://hr.wikipedia.org/wiki/Pepti%C4%8Dki_ulkus" title="Peptički ulkus – Croatian" lang="hr" hreflang="hr" data-title="Peptički ulkus" data-language-autonym="Hrvatski" data-language-local-name="Croatian" class="interlanguage-link-target"><span>Hrvatski</span></a></li><li class="interlanguage-link interwiki-id mw-list-item"><a href="https://id.wikipedia.org/wiki/Tukak_lambung" title="Tukak lambung – Indonesian" lang="id" hreflang="id" data-title="Tukak lambung" data-language-autonym="Bahasa Indonesia" data-language-local-name="Indonesian" class="interlanguage-link-target"><span>Bahasa Indonesia</span></a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Ulcera_peptica" title="Ulcera peptica – Italian" lang="it" hreflang="it" data-title="Ulcera peptica" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target"><span>Italiano</span></a></li><li class="interlanguage-link interwiki-he mw-list-item"><a href="https://he.wikipedia.org/wiki/%D7%9B%D7%99%D7%91_%D7%A2%D7%99%D7%9B%D7%95%D7%9C%D7%99" title="כיב עיכולי – Hebrew" lang="he" hreflang="he" data-title="כיב עיכולי" data-language-autonym="עברית" data-language-local-name="Hebrew" class="interlanguage-link-target"><span>עברית</span></a></li><li class="interlanguage-link interwiki-kn mw-list-item"><a href="https://kn.wikipedia.org/wiki/%E0%B2%9C%E0%B2%A0%E0%B2%B0/%E0%B2%9C%E0%B2%A0%E0%B2%B0%E0%B3%80%E0%B2%AF_%E0%B2%B9%E0%B3%81%E0%B2%A3%E0%B3%8D%E0%B2%A3%E0%B3%81/%E0%B2%B5%E0%B3%8D%E0%B2%B0%E0%B2%A3" title="ಜಠರ/ಜಠರೀಯ ಹುಣ್ಣು/ವ್ರಣ – Kannada" lang="kn" hreflang="kn" data-title="ಜಠರ/ಜಠರೀಯ ಹುಣ್ಣು/ವ್ರಣ" data-language-autonym="ಕನ್ನಡ" data-language-local-name="Kannada" class="interlanguage-link-target"><span>ಕನ್ನಡ</span></a></li><li class="interlanguage-link interwiki-ka mw-list-item"><a href="https://ka.wikipedia.org/wiki/%E1%83%9E%E1%83%94%E1%83%9E%E1%83%A2%E1%83%98%E1%83%99%E1%83%A3%E1%83%A0%E1%83%98_%E1%83%AC%E1%83%A7%E1%83%9A%E1%83%A3%E1%83%9A%E1%83%98" title="პეპტიკური წყლული – Georgian" lang="ka" hreflang="ka" data-title="პეპტიკური წყლული" data-language-autonym="ქართული" data-language-local-name="Georgian" class="interlanguage-link-target"><span>ქართული</span></a></li><li class="interlanguage-link interwiki-sw mw-list-item"><a href="https://sw.wikipedia.org/wiki/Kidonda_cha_duodenamu" title="Kidonda cha duodenamu – Swahili" lang="sw" hreflang="sw" data-title="Kidonda cha duodenamu" data-language-autonym="Kiswahili" data-language-local-name="Swahili" class="interlanguage-link-target"><span>Kiswahili</span></a></li><li class="interlanguage-link interwiki-ku mw-list-item"><a href="https://ku.wikipedia.org/wiki/Br%C3%AEna_heris%C3%AA" title="Brîna herisê – Kurdish" lang="ku" hreflang="ku" data-title="Brîna herisê" data-language-autonym="Kurdî" data-language-local-name="Kurdish" class="interlanguage-link-target"><span>Kurdî</span></a></li><li class="interlanguage-link interwiki-la mw-list-item"><a href="https://la.wikipedia.org/wiki/Ulcus_ventriculi" title="Ulcus ventriculi – Latin" lang="la" hreflang="la" data-title="Ulcus ventriculi" data-language-autonym="Latina" data-language-local-name="Latin" class="interlanguage-link-target"><span>Latina</span></a></li><li class="interlanguage-link interwiki-lv mw-list-item"><a href="https://lv.wikipedia.org/wiki/Peptisk%C4%81s_%C4%8D%C5%ABlas_slim%C4%ABba" title="Peptiskās čūlas slimība – Latvian" lang="lv" hreflang="lv" data-title="Peptiskās čūlas slimība" data-language-autonym="Latviešu" data-language-local-name="Latvian" class="interlanguage-link-target"><span>Latviešu</span></a></li><li class="interlanguage-link interwiki-hu mw-list-item"><a href="https://hu.wikipedia.org/wiki/Gyomorfek%C3%A9ly" title="Gyomorfekély – Hungarian" lang="hu" hreflang="hu" data-title="Gyomorfekély" data-language-autonym="Magyar" data-language-local-name="Hungarian" class="interlanguage-link-target"><span>Magyar</span></a></li><li class="interlanguage-link interwiki-mk mw-list-item"><a href="https://mk.wikipedia.org/wiki/%D0%A7%D0%B8%D1%80_%D0%BD%D0%B0_%D0%B6%D0%B5%D0%BB%D1%83%D0%B4%D0%BD%D0%B8%D0%BA%D0%BE%D1%82" title="Чир на желудникот – Macedonian" lang="mk" hreflang="mk" data-title="Чир на желудникот" data-language-autonym="Македонски" data-language-local-name="Macedonian" class="interlanguage-link-target"><span>Македонски</span></a></li><li class="interlanguage-link interwiki-ml mw-list-item"><a href="https://ml.wikipedia.org/wiki/%E0%B4%AA%E0%B5%86%E0%B4%AA%E0%B5%8D%E0%B4%B1%E0%B5%8D%E0%B4%B1%E0%B4%BF%E0%B4%95%E0%B5%8D_%E0%B4%85%E0%B5%BE%E0%B4%B8%E0%B5%BC" title="പെപ്റ്റിക് അൾസർ – Malayalam" lang="ml" hreflang="ml" data-title="പെപ്റ്റിക് അൾസർ" data-language-autonym="മലയാളം" data-language-local-name="Malayalam" class="interlanguage-link-target"><span>മലയാളം</span></a></li><li class="interlanguage-link interwiki-ms mw-list-item"><a href="https://ms.wikipedia.org/wiki/Ulser_peptik" title="Ulser peptik – Malay" lang="ms" hreflang="ms" data-title="Ulser peptik" data-language-autonym="Bahasa Melayu" data-language-local-name="Malay" class="interlanguage-link-target"><span>Bahasa Melayu</span></a></li><li class="interlanguage-link interwiki-nl mw-list-item"><a href="https://nl.wikipedia.org/wiki/Maagzweer" title="Maagzweer – Dutch" lang="nl" hreflang="nl" data-title="Maagzweer" data-language-autonym="Nederlands" data-language-local-name="Dutch" class="interlanguage-link-target"><span>Nederlands</span></a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a href="https://ja.wikipedia.org/wiki/%E6%B6%88%E5%8C%96%E6%80%A7%E6%BD%B0%E7%98%8D" title="消化性潰瘍 – Japanese" lang="ja" hreflang="ja" data-title="消化性潰瘍" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target"><span>日本語</span></a></li><li class="interlanguage-link interwiki-no mw-list-item"><a href="https://no.wikipedia.org/wiki/Mages%C3%A5r" title="Magesår – Norwegian Bokmål" lang="nb" hreflang="nb" data-title="Magesår" data-language-autonym="Norsk bokmål" data-language-local-name="Norwegian Bokmål" class="interlanguage-link-target"><span>Norsk bokmål</span></a></li><li class="interlanguage-link interwiki-nn mw-list-item"><a href="https://nn.wikipedia.org/wiki/Mages%C3%A5r" title="Magesår – Norwegian Nynorsk" lang="nn" hreflang="nn" data-title="Magesår" data-language-autonym="Norsk nynorsk" data-language-local-name="Norwegian Nynorsk" class="interlanguage-link-target"><span>Norsk nynorsk</span></a></li><li class="interlanguage-link interwiki-or mw-list-item"><a href="https://or.wikipedia.org/wiki/%E0%AC%AA%E0%AC%BE%E0%AC%95%E0%AC%B8%E0%AD%8D%E0%AC%A5%E0%AC%B3%E0%AD%80_%E0%AC%98%E0%AC%BE%E0%AC%86" title="ପାକସ୍ଥଳୀ ଘାଆ – Odia" lang="or" hreflang="or" data-title="ପାକସ୍ଥଳୀ ଘାଆ" data-language-autonym="ଓଡ଼ିଆ" data-language-local-name="Odia" class="interlanguage-link-target"><span>ଓଡ଼ିଆ</span></a></li><li class="interlanguage-link interwiki-uz mw-list-item"><a href="https://uz.wikipedia.org/wiki/Yara_kasalligi" title="Yara kasalligi – Uzbek" lang="uz" hreflang="uz" data-title="Yara kasalligi" data-language-autonym="Oʻzbekcha / ўзбекча" data-language-local-name="Uzbek" class="interlanguage-link-target"><span>Oʻzbekcha / ўзбекча</span></a></li><li class="interlanguage-link interwiki-pa mw-list-item"><a href="https://pa.wikipedia.org/wiki/%E0%A8%AA%E0%A9%87%E0%A8%AA%E0%A8%9F%E0%A8%BF%E0%A8%95_%E0%A8%85%E0%A8%B2%E0%A8%B8%E0%A8%B0" title="ਪੇਪਟਿਕ ਅਲਸਰ – Punjabi" lang="pa" hreflang="pa" data-title="ਪੇਪਟਿਕ ਅਲਸਰ" data-language-autonym="ਪੰਜਾਬੀ" data-language-local-name="Punjabi" class="interlanguage-link-target"><span>ਪੰਜਾਬੀ</span></a></li><li class="interlanguage-link interwiki-pl mw-list-item"><a href="https://pl.wikipedia.org/wiki/Choroba_wrzodowa" title="Choroba wrzodowa – Polish" lang="pl" hreflang="pl" data-title="Choroba wrzodowa" data-language-autonym="Polski" data-language-local-name="Polish" class="interlanguage-link-target"><span>Polski</span></a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/%C3%9Alcera_p%C3%A9ptica" title="Úlcera péptica – Portuguese" lang="pt" hreflang="pt" data-title="Úlcera péptica" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target"><span>Português</span></a></li><li class="interlanguage-link interwiki-ro mw-list-item"><a href="https://ro.wikipedia.org/wiki/Ulcer_gastroduodenal" title="Ulcer gastroduodenal – Romanian" lang="ro" hreflang="ro" data-title="Ulcer gastroduodenal" data-language-autonym="Română" data-language-local-name="Romanian" class="interlanguage-link-target"><span>Română</span></a></li><li class="interlanguage-link interwiki-ru mw-list-item"><a href="https://ru.wikipedia.org/wiki/%D0%AF%D0%B7%D0%B2%D0%B0_%D0%B6%D0%B5%D0%BB%D1%83%D0%B4%D0%BA%D0%B0" title="Язва желудка – Russian" lang="ru" hreflang="ru" data-title="Язва желудка" data-language-autonym="Русский" data-language-local-name="Russian" class="interlanguage-link-target"><span>Русский</span></a></li><li class="interlanguage-link interwiki-sah mw-list-item"><a href="https://sah.wikipedia.org/wiki/%D0%9A%D1%83%D1%80%D1%82%D0%B0%D1%85_%D0%B1%D0%B0%D0%B0%D2%BB%D0%B0" title="Куртах бааһа – Yakut" lang="sah" hreflang="sah" data-title="Куртах бааһа" data-language-autonym="Саха тыла" data-language-local-name="Yakut" class="interlanguage-link-target"><span>Саха тыла</span></a></li><li class="interlanguage-link interwiki-sq mw-list-item"><a href="https://sq.wikipedia.org/wiki/Ul%C3%A7era_n%C3%AB_stomak" title="Ulçera në stomak – Albanian" lang="sq" hreflang="sq" data-title="Ulçera në stomak" data-language-autonym="Shqip" data-language-local-name="Albanian" class="interlanguage-link-target"><span>Shqip</span></a></li><li class="interlanguage-link interwiki-simple mw-list-item"><a href="https://simple.wikipedia.org/wiki/Peptic_ulcer" title="Peptic ulcer – Simple English" lang="en-simple" hreflang="en-simple" data-title="Peptic ulcer" data-language-autonym="Simple English" data-language-local-name="Simple English" class="interlanguage-link-target"><span>Simple English</span></a></li><li class="interlanguage-link interwiki-sk mw-list-item"><a href="https://sk.wikipedia.org/wiki/Peptick%C3%BD_vred" title="Peptický vred – Slovak" lang="sk" hreflang="sk" data-title="Peptický vred" data-language-autonym="Slovenčina" data-language-local-name="Slovak" class="interlanguage-link-target"><span>Slovenčina</span></a></li><li class="interlanguage-link interwiki-sl mw-list-item"><a href="https://sl.wikipedia.org/wiki/Pepti%C4%8Dna_razjeda" title="Peptična razjeda – Slovenian" lang="sl" hreflang="sl" data-title="Peptična razjeda" data-language-autonym="Slovenščina" data-language-local-name="Slovenian" class="interlanguage-link-target"><span>Slovenščina</span></a></li><li class="interlanguage-link interwiki-ckb mw-list-item"><a href="https://ckb.wikipedia.org/wiki/%DA%BE%DB%95%D8%B1%D8%B3%DB%95_%D8%A8%D8%B1%DB%8C%D9%86" title="ھەرسە برین – Central Kurdish" lang="ckb" hreflang="ckb" data-title="ھەرسە برین" data-language-autonym="کوردی" data-language-local-name="Central Kurdish" class="interlanguage-link-target"><span>کوردی</span></a></li><li class="interlanguage-link interwiki-sr mw-list-item"><a href="https://sr.wikipedia.org/wiki/%D0%A7%D0%B8%D1%80_%D0%BD%D0%B0_%D0%B4%D0%B2%D0%B0%D0%BD%D0%B0%D0%B5%D1%81%D1%82%D0%BE%D0%BF%D0%B0%D0%BB%D0%B0%D1%87%D0%BD%D0%BE%D0%BC_%D1%86%D1%80%D0%B5%D0%B2%D1%83" title="Чир на дванаестопалачном цреву – Serbian" lang="sr" hreflang="sr" data-title="Чир на дванаестопалачном цреву" data-language-autonym="Српски / srpski" data-language-local-name="Serbian" class="interlanguage-link-target"><span>Српски / srpski</span></a></li><li class="interlanguage-link interwiki-sh mw-list-item"><a href="https://sh.wikipedia.org/wiki/%C4%8Cir_na_dvanaestopala%C4%8Dnom_crevu" title="Čir na dvanaestopalačnom crevu – Serbo-Croatian" lang="sh" hreflang="sh" data-title="Čir na dvanaestopalačnom crevu" data-language-autonym="Srpskohrvatski / српскохрватски" data-language-local-name="Serbo-Croatian" class="interlanguage-link-target"><span>Srpskohrvatski / српскохрватски</span></a></li><li class="interlanguage-link interwiki-fi mw-list-item"><a href="https://fi.wikipedia.org/wiki/Mahahaava" title="Mahahaava – Finnish" lang="fi" hreflang="fi" data-title="Mahahaava" data-language-autonym="Suomi" data-language-local-name="Finnish" class="interlanguage-link-target"><span>Suomi</span></a></li><li class="interlanguage-link interwiki-sv mw-list-item"><a href="https://sv.wikipedia.org/wiki/Mags%C3%A5r" title="Magsår – Swedish" lang="sv" hreflang="sv" data-title="Magsår" data-language-autonym="Svenska" data-language-local-name="Swedish" class="interlanguage-link-target"><span>Svenska</span></a></li><li class="interlanguage-link interwiki-ta mw-list-item"><a href="https://ta.wikipedia.org/wiki/%E0%AE%B5%E0%AE%AF%E0%AE%BF%E0%AE%B1%E0%AF%8D%E0%AE%B1%E0%AF%81%E0%AE%AA%E0%AF%8D_%E0%AE%AA%E0%AF%81%E0%AE%A3%E0%AF%8D" title="வயிற்றுப் புண் – Tamil" lang="ta" hreflang="ta" data-title="வயிற்றுப் புண்" data-language-autonym="தமிழ்" data-language-local-name="Tamil" class="interlanguage-link-target"><span>தமிழ்</span></a></li><li class="interlanguage-link interwiki-tt mw-list-item"><a href="https://tt.wikipedia.org/wiki/%D0%90%D1%88%D0%BA%D0%B0%D0%B7%D0%B0%D0%BD%D1%8B_%D2%97%D3%99%D1%80%D3%99%D1%85%D3%99%D1%82%D0%B5" title="Ашказаны җәрәхәте – Tatar" lang="tt" hreflang="tt" data-title="Ашказаны җәрәхәте" data-language-autonym="Татарча / tatarça" data-language-local-name="Tatar" class="interlanguage-link-target"><span>Татарча / tatarça</span></a></li><li class="interlanguage-link interwiki-te mw-list-item"><a href="https://te.wikipedia.org/wiki/%E0%B0%95%E0%B0%A1%E0%B1%81%E0%B0%AA%E0%B1%81%E0%B0%B2%E0%B1%8B_%E0%B0%AA%E0%B1%81%E0%B0%82%E0%B0%A1%E0%B1%81" title="కడుపులో పుండు – Telugu" lang="te" hreflang="te" data-title="కడుపులో పుండు" data-language-autonym="తెలుగు" data-language-local-name="Telugu" class="interlanguage-link-target"><span>తెలుగు</span></a></li><li class="interlanguage-link interwiki-th mw-list-item"><a href="https://th.wikipedia.org/wiki/%E0%B9%82%E0%B8%A3%E0%B8%84%E0%B9%81%E0%B8%9C%E0%B8%A5%E0%B9%80%E0%B8%9B%E0%B8%B7%E0%B9%88%E0%B8%AD%E0%B8%A2%E0%B9%80%E0%B8%9E%E0%B8%9B%E0%B8%95%E0%B8%B4%E0%B8%81" title="โรคแผลเปื่อยเพปติก – Thai" lang="th" hreflang="th" data-title="โรคแผลเปื่อยเพปติก" data-language-autonym="ไทย" data-language-local-name="Thai" class="interlanguage-link-target"><span>ไทย</span></a></li><li class="interlanguage-link interwiki-tr mw-list-item"><a href="https://tr.wikipedia.org/wiki/Peptik_%C3%BClser" title="Peptik ülser – Turkish" lang="tr" hreflang="tr" data-title="Peptik ülser" data-language-autonym="Türkçe" data-language-local-name="Turkish" class="interlanguage-link-target"><span>Türkçe</span></a></li><li class="interlanguage-link interwiki-uk mw-list-item"><a href="https://uk.wikipedia.org/wiki/%D0%9F%D0%B5%D0%BF%D1%82%D0%B8%D1%87%D0%BD%D0%B0_%D0%B2%D0%B8%D1%80%D0%B0%D0%B7%D0%BA%D0%B0" title="Пептична виразка – Ukrainian" lang="uk" hreflang="uk" data-title="Пептична виразка" data-language-autonym="Українська" data-language-local-name="Ukrainian" class="interlanguage-link-target"><span>Українська</span></a></li><li class="interlanguage-link interwiki-ur mw-list-item"><a href="https://ur.wikipedia.org/wiki/%D8%B2%D8%AE%D9%85_%DB%81%D8%A7%D8%B6%D9%85" title="زخم ہاضم – Urdu" lang="ur" hreflang="ur" data-title="زخم ہاضم" data-language-autonym="اردو" data-language-local-name="Urdu" class="interlanguage-link-target"><span>اردو</span></a></li><li class="interlanguage-link interwiki-vi mw-list-item"><a href="https://vi.wikipedia.org/wiki/Vi%C3%AAm_lo%C3%A9t_d%E1%BA%A1_d%C3%A0y_t%C3%A1_tr%C3%A0ng" title="Viêm loét dạ dày tá tràng – Vietnamese" lang="vi" hreflang="vi" data-title="Viêm loét dạ dày tá tràng" data-language-autonym="Tiếng Việt" data-language-local-name="Vietnamese" class="interlanguage-link-target"><span>Tiếng Việt</span></a></li><li class="interlanguage-link interwiki-wuu mw-list-item"><a href="https://wuu.wikipedia.org/wiki/%E8%83%83%E6%90%AD%E5%8D%81%E4%BA%8C%E6%8C%87%E8%82%A0%E6%BA%83%E7%96%A1" title="胃搭十二指肠溃疡 – Wu" lang="wuu" hreflang="wuu" data-title="胃搭十二指肠溃疡" data-language-autonym="吴语" data-language-local-name="Wu" class="interlanguage-link-target"><span>吴语</span></a></li><li class="interlanguage-link interwiki-zh-yue mw-list-item"><a href="https://zh-yue.wikipedia.org/wiki/%E6%B6%88%E5%8C%96%E6%80%A7%E6%BD%B0%E7%98%8D" title="消化性潰瘍 – Cantonese" lang="yue" hreflang="yue" data-title="消化性潰瘍" data-language-autonym="粵語" data-language-local-name="Cantonese" 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condition</div><style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox infobox-has-images-with-white-backgrounds"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Peptic ulcer disease</th></tr><tr><th scope="row" class="infobox-label">Other names</th><td class="infobox-data">Peptic ulcer, stomach ulcer, gastric ulcer, duodenal ulcer</td></tr><tr><td colspan="2" class="infobox-full-data"><span class="mw-default-size" typeof="mw:File/Frameless"><a href="/wiki/File:Deep_gastric_ulcer.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/7/7d/Deep_gastric_ulcer.png/220px-Deep_gastric_ulcer.png" decoding="async" width="220" height="219" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/7/7d/Deep_gastric_ulcer.png/330px-Deep_gastric_ulcer.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/7/7d/Deep_gastric_ulcer.png/440px-Deep_gastric_ulcer.png 2x" data-file-width="467" data-file-height="464" /></a></span></td></tr><tr><td colspan="2" class="infobox-full-data">An <a href="/wiki/Esophagogastroduodenoscopy" title="Esophagogastroduodenoscopy">endoscopic image</a> showing deep gastric ulcer.</td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="/wiki/Gastroenterology" title="Gastroenterology">Gastroenterology</a><br /><a href="/wiki/General_surgery" title="General surgery">General surgery</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Signs_and_symptoms" title="Signs and symptoms">Symptoms</a></th><td class="infobox-data"><a href="/wiki/Heartburn" title="Heartburn">Heartburn</a>, <a href="/wiki/Upper_abdominal_pain" class="mw-redirect" title="Upper abdominal pain">upper abdominal pain</a>, <a href="/wiki/Nausea" title="Nausea">nausea</a>, <a href="/wiki/Belching" class="mw-redirect" title="Belching">belching</a>, <a href="/wiki/Hematemesis" title="Hematemesis">vomiting</a>, <a href="/wiki/Melena" title="Melena">blood in the stool</a>, <a href="/wiki/Weight_loss" title="Weight loss">weight loss</a>, <a href="/wiki/Weight_gain" title="Weight gain">weight gain</a>, <a href="/wiki/Bloating" title="Bloating">bloating</a>, <a href="/wiki/Loss_of_appetite" class="mw-redirect" title="Loss of appetite">loss of appetite</a>,<sup id="cite_ref-Na2011_1-0" class="reference"><a href="#cite_note-Na2011-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Jaundice" title="Jaundice">yellowing of the skin and whites of the eyes</a>, <a href="/wiki/Dysphagia" title="Dysphagia">difficulty swallowing</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Complication_(medicine)" title="Complication (medicine)">Complications</a></th><td class="infobox-data"><a href="/wiki/Gastrointestinal_bleeding" title="Gastrointestinal bleeding">Bleeding</a>, <a href="/wiki/Gastrointestinal_perforation" title="Gastrointestinal perforation">perforation</a>, <a href="/wiki/Perforated_ulcer" title="Perforated ulcer">ulcer perforation</a>, <a href="/wiki/Gastric_outlet_obstruction" title="Gastric outlet obstruction">blockage of the stomach</a><sup id="cite_ref-Mil2011_2-0" class="reference"><a href="#cite_note-Mil2011-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Causes</th><td class="infobox-data"><i><a href="/wiki/Helicobacter_pylori" title="Helicobacter pylori">Helicobacter pylori</a></i> bacteria, <a href="/wiki/Non-steroidal_anti-inflammatory_drug" class="mw-redirect" title="Non-steroidal anti-inflammatory drug">non-steroidal anti-inflammatory drugs</a> (NSAIDs), <a href="/wiki/Tobacco_smoking" title="Tobacco smoking">tobacco smoking</a>, <a href="/wiki/Crohn%27s_disease" title="Crohn's disease">Crohn's disease</a><sup id="cite_ref-Na2011_1-1" class="reference"><a href="#cite_note-Na2011-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-St2002_3-0" class="reference"><a href="#cite_note-St2002-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_diagnosis" title="Medical diagnosis">Diagnostic method</a></th><td class="infobox-data">Based on symptoms, confirmed by <a href="/wiki/Endoscopy" title="Endoscopy">endoscopy</a> or <a href="/wiki/Barium_swallow" class="mw-redirect" title="Barium swallow">barium swallow</a><sup id="cite_ref-Na2011_1-2" class="reference"><a href="#cite_note-Na2011-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Differential_diagnosis" title="Differential diagnosis">Differential diagnosis</a></th><td class="infobox-data"><a href="/wiki/Gastric_cancer" class="mw-redirect" title="Gastric cancer">Stomach cancer</a>, <a href="/wiki/Coronary_heart_disease" class="mw-redirect" title="Coronary heart disease">coronary heart disease</a>, <a href="/wiki/Gastritis" title="Gastritis">inflammation of the stomach lining</a>, <a href="/wiki/Cholelithiasis" class="mw-redirect" title="Cholelithiasis">gallbladder inflammation</a><sup id="cite_ref-Na2011_1-3" class="reference"><a href="#cite_note-Na2011-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Treatment</th><td class="infobox-data">Medications,<sup id="cite_ref-Na2011_1-4" class="reference"><a href="#cite_note-Na2011-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> stopping NSAIDs, stopping smoking, stopping <a href="/wiki/Alcohol_(drug)" title="Alcohol (drug)">alcohol consumption</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medication" title="Medication">Medication</a></th><td class="infobox-data"><a href="/wiki/Proton_pump_inhibitor" class="mw-redirect" title="Proton pump inhibitor">Proton pump inhibitor</a>, <a href="/wiki/H2_blocker" class="mw-redirect" title="H2 blocker">H2 blocker</a>, <a href="/wiki/Antibiotics" class="mw-redirect" title="Antibiotics">antibiotics</a><sup id="cite_ref-Na2011_1-5" class="reference"><a href="#cite_note-Na2011-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Wang2011_4-0" class="reference"><a href="#cite_note-Wang2011-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Frequency</th><td class="infobox-data">87.4 million (2015)<sup id="cite_ref-GBD2015Pre_5-0" class="reference"><a href="#cite_note-GBD2015Pre-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Deaths</th><td class="infobox-data">267,500 (2015)<sup id="cite_ref-GBD2015De_6-0" class="reference"><a href="#cite_note-GBD2015De-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup></td></tr></tbody></table><style data-mw-deduplicate="TemplateStyles:r1236303919">@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-has-images-with-white-backgrounds img{background:white}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-has-images-with-white-backgrounds img{background:white}}</style> <p><b>Peptic ulcer disease</b> is when the inner part of the stomach's <a href="/wiki/Gastric_mucosa" title="Gastric mucosa">gastric mucosa</a> (lining of the stomach), the first part of the <a href="/wiki/Small_intestine" title="Small intestine">small intestine</a>, or sometimes the lower <a href="/wiki/Esophagus" title="Esophagus">esophagus</a>, gets damaged. An ulcer in the stomach is called a <b>gastric ulcer</b>, while one in the first part of the intestines is a <b>duodenal ulcer</b>.<sup id="cite_ref-Na2011_1-6" class="reference"><a href="#cite_note-Na2011-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> The most common symptoms of a duodenal ulcer are waking at night with <a href="/wiki/Epigastrium" title="Epigastrium">upper abdominal pain</a>, and upper <a href="/wiki/Abdominal_pain" title="Abdominal pain">abdominal pain</a> that improves with eating.<sup id="cite_ref-Na2011_1-7" class="reference"><a href="#cite_note-Na2011-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> With a gastric ulcer, the pain may worsen with eating.<sup id="cite_ref-7" class="reference"><a href="#cite_note-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> The pain is often described as a <a href="/wiki/Dyspepsia" class="mw-redirect" title="Dyspepsia">burning</a> or dull ache.<sup id="cite_ref-Na2011_1-8" class="reference"><a href="#cite_note-Na2011-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Other symptoms include <a href="/wiki/Belching" class="mw-redirect" title="Belching">belching</a>, vomiting, weight loss, or <a href="/wiki/Anorexia_(symptom)" title="Anorexia (symptom)">poor appetite</a>.<sup id="cite_ref-Na2011_1-9" class="reference"><a href="#cite_note-Na2011-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> About a third of older people with peptic ulcers have no symptoms.<sup id="cite_ref-Na2011_1-10" class="reference"><a href="#cite_note-Na2011-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Complications may include <a href="/wiki/Gastrointestinal_bleeding" title="Gastrointestinal bleeding">bleeding</a>, <a href="/wiki/Gastrointestinal_perforation" title="Gastrointestinal perforation">perforation</a>, and <a href="/wiki/Gastric_outlet_obstruction" title="Gastric outlet obstruction">blockage of the stomach</a>.<sup id="cite_ref-Mil2011_2-1" class="reference"><a href="#cite_note-Mil2011-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Bleeding occurs in as many as 15% of cases.<sup id="cite_ref-Mil2011_2-2" class="reference"><a href="#cite_note-Mil2011-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p><p>Common causes include infection with <i><a href="/wiki/Helicobacter_pylori" title="Helicobacter pylori">Helicobacter pylori</a></i> and <a href="/wiki/Non-steroidal_anti-inflammatory_drug" class="mw-redirect" title="Non-steroidal anti-inflammatory drug">non-steroidal anti-inflammatory drugs</a> (NSAIDs).<sup id="cite_ref-Na2011_1-11" class="reference"><a href="#cite_note-Na2011-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Other, less common causes include <a href="/wiki/Tobacco_smoking" title="Tobacco smoking">tobacco smoking</a>, stress as a result of other serious health conditions, <a href="/wiki/Beh%C3%A7et%27s_disease" title="Behçet's disease">Behçet's disease</a>, <a href="/wiki/Zollinger%E2%80%93Ellison_syndrome" title="Zollinger–Ellison syndrome">Zollinger–Ellison syndrome</a>, <a href="/wiki/Crohn%27s_disease" title="Crohn's disease">Crohn's disease</a>, and <a href="/wiki/Liver_cirrhosis" class="mw-redirect" title="Liver cirrhosis">liver cirrhosis</a>.<sup id="cite_ref-Na2011_1-12" class="reference"><a href="#cite_note-Na2011-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-St2002_3-1" class="reference"><a href="#cite_note-St2002-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> Older people are more sensitive to the ulcer-causing effects of NSAIDs.<sup id="cite_ref-Na2011_1-13" class="reference"><a href="#cite_note-Na2011-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> The diagnosis is typically suspected due to the presenting symptoms with confirmation by either <a href="/wiki/Endoscopy" title="Endoscopy">endoscopy</a> or <a href="/wiki/Barium_swallow" class="mw-redirect" title="Barium swallow">barium swallow</a>.<sup id="cite_ref-Na2011_1-14" class="reference"><a href="#cite_note-Na2011-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> <i>H. pylori</i> can be diagnosed by testing the blood for <a href="/wiki/Antibodies" class="mw-redirect" title="Antibodies">antibodies</a>, a <a href="/wiki/Urea_breath_test" title="Urea breath test">urea breath test</a>, testing the stool for signs of the bacteria, or a <a href="/wiki/Biopsy" title="Biopsy">biopsy</a> of the stomach.<sup id="cite_ref-Na2011_1-15" class="reference"><a href="#cite_note-Na2011-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Other conditions that produce similar symptoms include <a href="/wiki/Gastric_cancer" class="mw-redirect" title="Gastric cancer">stomach cancer</a>, <a href="/wiki/Coronary_heart_disease" class="mw-redirect" title="Coronary heart disease">coronary heart disease</a>, and <a href="/wiki/Gastritis" title="Gastritis">inflammation of the stomach lining</a> or <a href="/wiki/Cholelithiasis" class="mw-redirect" title="Cholelithiasis">gallbladder inflammation</a>.<sup id="cite_ref-Na2011_1-16" class="reference"><a href="#cite_note-Na2011-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p><p><a href="/wiki/Diet_(nutrition)" title="Diet (nutrition)">Diet</a> does not play an important role in either causing or preventing ulcers.<sup id="cite_ref-8" class="reference"><a href="#cite_note-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> Treatment includes stopping smoking, stopping use of NSAIDs, stopping <a href="/wiki/Alcohol_(drug)" title="Alcohol (drug)">alcohol</a>, and taking medications to decrease stomach acid.<sup id="cite_ref-Na2011_1-17" class="reference"><a href="#cite_note-Na2011-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> The medication used to decrease acid is usually either a <a href="/wiki/Proton_pump_inhibitor" class="mw-redirect" title="Proton pump inhibitor">proton pump inhibitor</a> (PPI) or an <a href="/wiki/H2_blocker" class="mw-redirect" title="H2 blocker">H2 blocker</a>, with four weeks of treatment initially recommended.<sup id="cite_ref-Na2011_1-18" class="reference"><a href="#cite_note-Na2011-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Ulcers due to <i>H. pylori</i> are treated with a combination of medications, such as <a href="/wiki/Amoxicillin" title="Amoxicillin">amoxicillin</a>, <a href="/wiki/Clarithromycin" title="Clarithromycin">clarithromycin</a>, and a PPI.<sup id="cite_ref-Wang2011_4-1" class="reference"><a href="#cite_note-Wang2011-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Antibiotic_resistance" class="mw-redirect" title="Antibiotic resistance">Antibiotic resistance</a> is increasing and thus treatment may not always be effective.<sup id="cite_ref-Wang2011_4-2" class="reference"><a href="#cite_note-Wang2011-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> Bleeding ulcers may be treated by <a href="/wiki/Endoscopy" title="Endoscopy">endoscopy</a>, with open surgery typically only used in cases in which it is not successful.<sup id="cite_ref-Mil2011_2-3" class="reference"><a href="#cite_note-Mil2011-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p><p>Peptic ulcers are present in around 4% of the population.<sup id="cite_ref-Na2011_1-19" class="reference"><a href="#cite_note-Na2011-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> New ulcers were found in around 87.4 million people worldwide during 2015.<sup id="cite_ref-GBD2015Pre_5-1" class="reference"><a href="#cite_note-GBD2015Pre-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> About 10% of people develop a peptic ulcer at some point in their life.<sup id="cite_ref-Snow2008_9-0" class="reference"><a href="#cite_note-Snow2008-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> Peptic ulcers resulted in 267,500 deaths in 2015, down from 327,000 in 1990.<sup id="cite_ref-GBD2015De_6-1" class="reference"><a href="#cite_note-GBD2015De-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-GDB2013_10-0" class="reference"><a href="#cite_note-GDB2013-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> The first description of a perforated peptic ulcer was in 1670, in Princess <a href="/wiki/Henrietta_of_England" title="Henrietta of England">Henrietta of England</a>.<sup id="cite_ref-Mil2011_2-4" class="reference"><a href="#cite_note-Mil2011-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> <i>H. pylori</i> was first identified as causing peptic ulcers by <a href="/wiki/Barry_Marshall" title="Barry Marshall">Barry Marshall</a> and <a href="/wiki/Robin_Warren" title="Robin Warren">Robin Warren</a> in the late 20th century,<sup id="cite_ref-Wang2011_4-3" class="reference"><a href="#cite_note-Wang2011-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> a discovery for which they received the <a href="/wiki/Nobel_Prize_in_Physiology_or_Medicine" title="Nobel Prize in Physiology or Medicine">Nobel Prize</a> in 2005.<sup id="cite_ref-Nobel_11-0" class="reference"><a href="#cite_note-Nobel-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> </p> <style data-mw-deduplicate="TemplateStyles:r886046785">.mw-parser-output .toclimit-2 .toclevel-1 ul,.mw-parser-output .toclimit-3 .toclevel-2 ul,.mw-parser-output .toclimit-4 .toclevel-3 ul,.mw-parser-output .toclimit-5 .toclevel-4 ul,.mw-parser-output .toclimit-6 .toclevel-5 ul,.mw-parser-output .toclimit-7 .toclevel-6 ul{display:none}</style><div class="toclimit-3"><meta property="mw:PageProp/toc" /></div> <div class="mw-heading mw-heading2"><h2 id="Signs_and_symptoms">Signs and symptoms</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Peptic_ulcer_disease&action=edit&section=1" title="Edit section: Signs and symptoms"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Gastric_Ulcer.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/8/8a/Gastric_Ulcer.png/260px-Gastric_Ulcer.png" decoding="async" width="260" height="156" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/8/8a/Gastric_Ulcer.png/390px-Gastric_Ulcer.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/8/8a/Gastric_Ulcer.png/520px-Gastric_Ulcer.png 2x" data-file-width="1200" data-file-height="720" /></a><figcaption>Gastric ulcer</figcaption></figure> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Duodenal_ulcer01.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/4/41/Duodenal_ulcer01.jpg/220px-Duodenal_ulcer01.jpg" decoding="async" width="220" height="163" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/4/41/Duodenal_ulcer01.jpg/330px-Duodenal_ulcer01.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/4/41/Duodenal_ulcer01.jpg/440px-Duodenal_ulcer01.jpg 2x" data-file-width="617" data-file-height="456" /></a><figcaption>Duodenal ulcer A2 stage, acute duodenal mucosal lesion (ADML)</figcaption></figure> <p>Signs and symptoms of a peptic ulcer can include one or more of the following:<sup id="cite_ref-:0_12-0" class="reference"><a href="#cite_note-:0-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> </p> <ul><li><a href="/wiki/Abdominal_pain" title="Abdominal pain">abdominal pain</a>, classically <a href="/wiki/Epigastric" class="mw-redirect" title="Epigastric">epigastric</a>, strongly correlated with mealtimes. In case of duodenal ulcers, the pain appears about three hours after taking a meal and wakes the person from sleep;</li> <li><a href="/wiki/Bloating" title="Bloating">bloating</a> and abdominal fullness;</li> <li><a href="/wiki/Hypersalivation" title="Hypersalivation">waterbrash</a> (a rush of saliva after an episode of regurgitation to dilute the acid in esophagus, although this is more associated with <a href="/wiki/Gastroesophageal_reflux_disease" title="Gastroesophageal reflux disease">gastroesophageal reflux disease</a>);</li> <li>nausea and copious vomiting;</li> <li><a href="/wiki/Anorexia_(symptom)" title="Anorexia (symptom)">loss of appetite</a> and weight loss, in gastric ulcer;</li> <li>weight gain, in duodenal ulcer, as the pain is relieved by eating;</li> <li><a href="/wiki/Hematemesis" title="Hematemesis">hematemesis</a> (vomiting of blood); this can occur due to bleeding directly from a gastric ulcer or from damage to the esophagus from severe/continuing vomiting.</li> <li><a href="/wiki/Melena" title="Melena">melena</a> (tarry, foul-smelling feces due to presence of <a href="/wiki/Oxidation" class="mw-redirect" title="Oxidation">oxidized</a> iron from <a href="/wiki/Hemoglobin" title="Hemoglobin">hemoglobin</a>);</li> <li>rarely, an ulcer can lead to a gastric or <a href="/wiki/Gastrointestinal_perforation" title="Gastrointestinal perforation">duodenal perforation</a>, which leads to <a href="/wiki/Acute_peritonitis" class="mw-redirect" title="Acute peritonitis">acute peritonitis</a> and extreme, stabbing pain,<sup id="cite_ref-13" class="reference"><a href="#cite_note-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> and requires immediate surgery.</li></ul> <p>A history of <a href="/wiki/Heartburn" title="Heartburn">heartburn</a> or <a href="/wiki/Gastroesophageal_reflux_disease" title="Gastroesophageal reflux disease">gastroesophageal reflux disease</a> (GERD) and use of certain medications can raise the suspicion for peptic ulcer. Medicines associated with peptic ulcer include <a href="/wiki/NSAID" class="mw-redirect" title="NSAID">NSAIDs</a> (non-steroidal anti-inflammatory drugs) that inhibit <a href="/wiki/Cyclooxygenase" title="Cyclooxygenase">cyclooxygenase</a> and most <a href="/wiki/Glucocorticoid" title="Glucocorticoid">glucocorticoids</a> (e.g., <a href="/wiki/Dexamethasone" title="Dexamethasone">dexamethasone</a> and <a href="/wiki/Prednisolone" title="Prednisolone">prednisolone</a>).<sup id="cite_ref-14" class="reference"><a href="#cite_note-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> </p><p>In people over the age of 45 with more than two weeks of the above symptoms, the odds for peptic ulceration are high enough to warrant rapid investigation by <a href="/wiki/Esophagogastroduodenoscopy" title="Esophagogastroduodenoscopy">esophagogastroduodenoscopy</a>.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (July 2022)">citation needed</span></a></i>]</sup> </p><p>The timing of symptoms in relation to the meal may differentiate between gastric and duodenal ulcers. A gastric ulcer would give <a href="/wiki/Epigastrium" title="Epigastrium">epigastric</a> pain during the meal, associated with nausea and vomiting, as <a href="/wiki/Gastric_acid" title="Gastric acid">gastric acid</a> production is increased as food enters the stomach. Pain in duodenal ulcers would be aggravated by hunger and relieved by a meal and is associated with night pain.<sup id="cite_ref-Angel_2017_15-0" class="reference"><a href="#cite_note-Angel_2017-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> </p><p>Also, the symptoms of peptic ulcers may vary with the location of the ulcer and the person's age. Furthermore, typical ulcers tend to heal and recur, and as a result the pain may occur for few days and weeks and then wane or disappear.<sup id="cite_ref-Peptic_Ulcer_16-0" class="reference"><a href="#cite_note-Peptic_Ulcer-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> Usually, children and the <a href="/wiki/Elderly" class="mw-redirect" title="Elderly">elderly</a> do not develop any symptoms unless complications have arisen. </p><p>A burning or gnawing feeling in the stomach area lasting between 30 minutes and 3 hours commonly accompanies ulcers. This pain can be misinterpreted as <a href="/wiki/Hunger" title="Hunger">hunger</a>, <a href="/wiki/Indigestion" title="Indigestion">indigestion</a>, or <a href="/wiki/Heartburn" title="Heartburn">heartburn</a>. Pain is usually caused by the ulcer, but it may be aggravated by the <a href="/wiki/Stomach_acid" class="mw-redirect" title="Stomach acid">stomach acid</a> when it comes into contact with the ulcerated area. The pain caused by peptic ulcers can be felt anywhere from the navel up to the <a href="/wiki/Human_sternum" class="mw-redirect" title="Human sternum">sternum</a>, it may last from few minutes to several hours, and it may be worse when the stomach is empty. Also, sometimes the pain may flare at night, and it can commonly be temporarily relieved by eating foods that buffer stomach acid or by taking anti-acid medication.<sup id="cite_ref-17" class="reference"><a href="#cite_note-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> However, peptic ulcer disease symptoms may be different for everyone.<sup id="cite_ref-18" class="reference"><a href="#cite_note-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Complications">Complications</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Peptic_ulcer_disease&action=edit&section=2" title="Edit section: Complications"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/Upper_gastrointestinal_bleeding" title="Upper gastrointestinal bleeding">Gastrointestinal bleeding</a> is the most common complication. Sudden large bleeding can be life-threatening.<sup id="cite_ref-pmid9391242_19-0" class="reference"><a href="#cite_note-pmid9391242-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-20" class="reference"><a href="#cite_note-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> It is associated with 5% to 10% death rate.<sup id="cite_ref-Angel_2017_15-1" class="reference"><a href="#cite_note-Angel_2017-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup></li> <li><a href="/wiki/Gastrointestinal_perforation" title="Gastrointestinal perforation">Perforation</a> (a hole in the <a href="/wiki/Gastrointestinal_wall" title="Gastrointestinal wall">wall of the gastrointestinal tract</a>) following a gastric ulcer often leads to catastrophic consequences if left untreated. Erosion of the gastrointestinal wall by the ulcer leads to spillage of the stomach or intestinal contents into the abdominal cavity, leading to an acute chemical <a href="/wiki/Peritonitis" title="Peritonitis">peritonitis</a>.<sup id="cite_ref-21" class="reference"><a href="#cite_note-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> The first sign is often sudden intense abdominal pain,<sup id="cite_ref-Angel_2017_15-2" class="reference"><a href="#cite_note-Angel_2017-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> as seen in <a href="/wiki/Valentino%27s_syndrome" title="Valentino's syndrome">Valentino's syndrome</a>. Posterior gastric wall perforation may lead to bleeding due to the involvement of gastroduodenal artery that lies posterior to the first part of the duodenum.<sup id="cite_ref-22" class="reference"><a href="#cite_note-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> The death rate in this case is 20%.<sup id="cite_ref-Angel_2017_15-3" class="reference"><a href="#cite_note-Angel_2017-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup></li> <li>Penetration is a form of perforation in which the hole leads to and the ulcer continues into adjacent organs such as the <a href="/wiki/Liver" title="Liver">liver</a> and <a href="/wiki/Pancreas" title="Pancreas">pancreas</a>.<sup id="cite_ref-Peptic_Ulcer_16-1" class="reference"><a href="#cite_note-Peptic_Ulcer-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup></li> <li><a href="/wiki/Gastric_outlet_obstruction" title="Gastric outlet obstruction">Gastric outlet obstruction</a> (stenosis) is a narrowing of the pyloric canal by scarring and swelling of the gastric antrum and duodenum due to peptic ulcers. The person often presents with severe vomiting.<sup id="cite_ref-Angel_2017_15-4" class="reference"><a href="#cite_note-Angel_2017-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup></li> <li>Cancer is included in the differential diagnosis (elucidated by <a href="/wiki/Biopsy" title="Biopsy">biopsy</a>), <i><a href="/wiki/Helicobacter_pylori" title="Helicobacter pylori">Helicobacter pylori</a></i> as the etiological factor making it 3 to 6 times more likely to develop stomach cancer from the ulcer.<sup id="cite_ref-Peptic_Ulcer_16-2" class="reference"><a href="#cite_note-Peptic_Ulcer-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> The risk for developing gastrointestinal cancer also appears to be slightly higher with gastric ulcers.<sup id="cite_ref-23" class="reference"><a href="#cite_note-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup></li></ul> <div class="mw-heading mw-heading2"><h2 id="Cause">Cause</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Peptic_ulcer_disease&action=edit&section=3" title="Edit section: Cause"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-heading mw-heading3"><h3 id="H._pylori"><i>H. pylori</i></h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Peptic_ulcer_disease&action=edit&section=4" title="Edit section: H. pylori"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><i><a href="/wiki/Helicobacter_pylori" title="Helicobacter pylori">Helicobacter pylori</a></i> is one of the major causative factors of peptic ulcer disease. It secretes <a href="/wiki/Urease" title="Urease">urease</a> to create an alkaline environment, which is suitable for its survival. It expresses blood group antigen-binding adhesin (BabA) and outer inflammatory protein adhesin (OipA), which enables it to attach to the gastric epithelium. The bacterium also expresses virulence factors such as <i>CagA</i> and <i>PicB</i>, which cause stomach mucosal inflammation. The VacA gene encodes for vacuolating cytotoxin, but its mechanism of causing peptic ulcers is unclear. Such stomach mucosal inflammation can be associated with <a href="/wiki/Hyperchlorhydria" title="Hyperchlorhydria">hyperchlorhydria</a> (increased stomach acid secretion) or <a href="/wiki/Hypochlorhydria" class="mw-redirect" title="Hypochlorhydria">hypochlorhydria</a> (reduced stomach acid secretion). Inflammatory <a href="/wiki/Cytokine" title="Cytokine">cytokines</a> inhibit the <a href="/wiki/Parietal_cell" title="Parietal cell">parietal cell</a> acid secretion. <i>H. pylori</i> also secretes certain products that inhibit <a href="/wiki/Hydrogen_potassium_ATPase" title="Hydrogen potassium ATPase">hydrogen potassium ATPase</a>; activate <a href="/wiki/Calcitonin_gene-related_peptide" title="Calcitonin gene-related peptide">calcitonin gene-related peptide</a> sensory neurons, which increases <a href="/wiki/Somatostatin" title="Somatostatin">somatostatin</a> secretion to inhibit acid production by parietal cells; and inhibit <a href="/wiki/Gastrin" title="Gastrin">gastrin</a> secretion. This reduction in acid production causes gastric ulcers.<sup id="cite_ref-Angel_2017_15-5" class="reference"><a href="#cite_note-Angel_2017-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> On the other hand, increased acid production at the <a href="/wiki/Pyloric_antrum" class="mw-redirect" title="Pyloric antrum">pyloric antrum</a> is associated with duodenal ulcers in 10% to 15% of <i>H. pylori</i> infection cases. In this case, somatostatin production is reduced and gastrin production is increased, leading to increased <a href="/wiki/Histamine" title="Histamine">histamine</a> secretion from the <a href="/wiki/Enterochromaffin" class="mw-redirect" title="Enterochromaffin">enterochromaffin</a> cells, thus increasing acid production. An acidic environment at the antrum causes <a href="/wiki/Metaplasia" title="Metaplasia">metaplasia</a> of the duodenal cells, causing duodenal ulcers.<sup id="cite_ref-Angel_2017_15-6" class="reference"><a href="#cite_note-Angel_2017-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> </p><p>Human immune response toward the bacteria also determines the emergence of peptic ulcer disease. The human IL1B gene encodes for <a href="/wiki/Interleukin_1_beta" title="Interleukin 1 beta">Interleukin 1 beta</a>, and other genes that encode for <a href="/wiki/Tumour_necrosis_factor" class="mw-redirect" title="Tumour necrosis factor">tumour necrosis factor</a> (TNF) and <a href="/wiki/Lymphotoxin_alpha" title="Lymphotoxin alpha">Lymphotoxin alpha</a> also play a role in gastric inflammation.<sup id="cite_ref-Angel_2017_15-7" class="reference"><a href="#cite_note-Angel_2017-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="NSAIDs">NSAIDs</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Peptic_ulcer_disease&action=edit&section=5" title="Edit section: NSAIDs"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Taking <a href="/wiki/Nonsteroidal_anti-inflammatory_drug" title="Nonsteroidal anti-inflammatory drug">nonsteroidal anti-inflammatory drugs</a> (NSAIDs) such as <a href="/wiki/Aspirin" title="Aspirin">aspirin</a><sup id="cite_ref-24" class="reference"><a href="#cite_note-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> can increase the risk of peptic ulcer disease by four times compared to non-users. The risk of getting a peptic ulcer is two times for aspirin users. Risk of bleeding increases if NSAIDs are combined with <a href="/wiki/Selective_serotonin_reuptake_inhibitor" title="Selective serotonin reuptake inhibitor">selective serotonin reuptake inhibitor</a> (SSRI), <a href="/wiki/Corticosteroid" title="Corticosteroid">corticosteroids</a>, <a href="/wiki/Antimineralocorticoid" class="mw-redirect" title="Antimineralocorticoid">antimineralocorticoids</a>, and <a href="/wiki/Anticoagulants" class="mw-redirect" title="Anticoagulants">anticoagulants</a>. The gastric mucosa protects itself from <a href="/wiki/Gastric_acid" title="Gastric acid">gastric acid</a> with a layer of mucus, the secretion of which is stimulated by certain <a href="/wiki/Prostaglandin" title="Prostaglandin">prostaglandins</a>. NSAIDs block the function of <a href="/wiki/Cyclooxygenase" title="Cyclooxygenase">cyclooxygenase</a> 1 (<i>COX-1</i>), which is essential for the production of these prostaglandins. Besides this, NSAIDs also inhibit stomach mucosa cells proliferation and mucosal blood flow, reducing <a href="/wiki/Bicarbonate" title="Bicarbonate">bicarbonate</a> and mucus secretion, which reduces the integrity of the mucosa. Another type of NSAIDs, called COX-2 selective anti-inflammatory drugs (such as <a href="/wiki/Celecoxib" title="Celecoxib">celecoxib</a>), preferentially inhibit <i>COX-2</i>, which is less essential in the gastric mucosa. This reduces the probability of getting peptic ulcers; however, it can still delay ulcer healing for those who already have a peptic ulcer.<sup id="cite_ref-Angel_2017_15-8" class="reference"><a href="#cite_note-Angel_2017-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> Peptic ulcers caused by NSAIDs differ from those caused by <i>H. pylori</i> as the latter's appear as a consequence of inflammation of the mucosa (presence of neutrophil and submucosal edema), the former instead as a consequence of a direct damage of the NSAID molecule against COX enzymes, altering the hydrophobic state of the mucus, the permeability of the lining epithelium and mitochondrial machinery of the cell itself. In this way NSAID's ulcers tend to complicate faster and dig deeper in the tissue causing more complications, often asymptomatically until a great portion of the tissue is involved.<sup id="cite_ref-25" class="reference"><a href="#cite_note-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-26" class="reference"><a href="#cite_note-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Stress">Stress</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Peptic_ulcer_disease&action=edit&section=6" title="Edit section: Stress"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Physiological (not psychological) <a href="/wiki/Stress_(biology)" title="Stress (biology)">stress</a> due to serious health problems, such as those requiring treatment in an intensive care unit, is well described as a cause of peptic ulcers, which are also known as <a href="/wiki/Stress_ulcer" title="Stress ulcer">stress ulcers</a>.<sup id="cite_ref-St2002_3-2" class="reference"><a href="#cite_note-St2002-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> </p><p>While chronic life stress was once believed to be the main cause of ulcers, this is no longer the case.<sup id="cite_ref-Fink2011_27-0" class="reference"><a href="#cite_note-Fink2011-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> It is, however, still occasionally believed to play a role.<sup id="cite_ref-Fink2011_27-1" class="reference"><a href="#cite_note-Fink2011-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> This may be due to the well-documented effects of stress on gastric physiology, increasing the risk in those with other causes, such as <i>H. pylori</i> or NSAID use.<sup id="cite_ref-28" class="reference"><a href="#cite_note-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Diet">Diet</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Peptic_ulcer_disease&action=edit&section=7" title="Edit section: Diet"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Diet_(nutrition)" title="Diet (nutrition)">Dietary</a> factors, such as <a href="/wiki/Spice" title="Spice">spice</a> consumption, were hypothesized to cause ulcers until the late 20th century, but have been shown to be of relatively minor importance.<sup id="cite_ref-29" class="reference"><a href="#cite_note-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> Caffeine and coffee, also commonly thought to cause or exacerbate ulcers, appear to have little effect.<sup id="cite_ref-30" class="reference"><a href="#cite_note-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-31" class="reference"><a href="#cite_note-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> Similarly, while studies have found that alcohol consumption increases risk when associated with <i>H. pylori</i> infection, it does not seem to independently increase risk. Even when coupled with <i>H. pylori</i> infection, the increase is modest in comparison to the primary risk factor.<sup id="cite_ref-salih2007_32-0" class="reference"><a href="#cite_note-salih2007-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Sonnenberg1981_33-0" class="reference"><a href="#cite_note-Sonnenberg1981-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-34" class="reference"><a href="#cite_note-34"><span class="cite-bracket">[</span>nb 1<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Other">Other</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Peptic_ulcer_disease&action=edit&section=8" title="Edit section: Other"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Other causes of peptic ulcer disease include gastric <a href="/wiki/Ischaemia" class="mw-redirect" title="Ischaemia">ischaemia</a>, drugs, metabolic disturbances, <a href="/wiki/Cytomegalovirus" title="Cytomegalovirus">cytomegalovirus</a> (CMV), upper abdominal radiotherapy, <a href="/wiki/Crohn%27s_disease" title="Crohn's disease">Crohn's disease</a>, and <a href="/wiki/Vasculitis" title="Vasculitis">vasculitis</a>.<sup id="cite_ref-Angel_2017_15-9" class="reference"><a href="#cite_note-Angel_2017-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Gastrinoma" title="Gastrinoma">Gastrinomas</a> (<a href="/wiki/Zollinger%E2%80%93Ellison_syndrome" title="Zollinger–Ellison syndrome">Zollinger–Ellison syndrome</a>), or rare gastrin-secreting tumors, also cause multiple and difficult-to-heal ulcers.<sup id="cite_ref-35" class="reference"><a href="#cite_note-35"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> </p><p>It is still unclear whether smoking increases the risk of getting peptic ulcers.<sup id="cite_ref-Angel_2017_15-10" class="reference"><a href="#cite_note-Angel_2017-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Diagnosis">Diagnosis</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Peptic_ulcer_disease&action=edit&section=9" title="Edit section: Diagnosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size mw-halign-right" typeof="mw:File/Thumb"><a href="/wiki/File:Gastric_ulcer_3.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/f/f2/Gastric_ulcer_3.jpg/260px-Gastric_ulcer_3.jpg" decoding="async" width="260" height="232" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/f/f2/Gastric_ulcer_3.jpg 1.5x" data-file-width="332" data-file-height="296" /></a><figcaption>Endoscopic image of gastric ulcer, biopsy proven to be <a href="/wiki/Gastric_cancer" class="mw-redirect" title="Gastric cancer">gastric cancer</a>.</figcaption></figure> <p>The diagnosis is mainly established based on the characteristic symptoms. Stomach pain is the most common sign of a peptic ulcer.<sup id="cite_ref-:0_12-1" class="reference"><a href="#cite_note-:0-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> </p><p>More specifically, peptic ulcers erode the <a href="/wiki/Muscularis_mucosae" title="Muscularis mucosae">muscularis mucosae</a>, at minimum reaching to the level of the submucosa (contrast with erosions, which do not involve the muscularis mucosae).<sup id="cite_ref-36" class="reference"><a href="#cite_note-36"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup> </p><p>Confirmation of the diagnosis is made with the help of tests such as endoscopies or barium contrast <a href="/wiki/X-ray" title="X-ray">x-rays</a>. The tests are typically ordered if the symptoms do not resolve after a few weeks of treatment, or when they first appear in a person who is over age 45 or who has other symptoms such as <a href="/wiki/Weight_loss" title="Weight loss">weight loss</a>, because <a href="/wiki/Stomach_cancer" title="Stomach cancer">stomach cancer</a> can cause similar symptoms. Also, when severe ulcers resist treatment, particularly if a person has several ulcers or the ulcers are in unusual places, a doctor may suspect an underlying condition that causes the stomach to overproduce <a href="/wiki/Acid" title="Acid">acid</a>.<sup id="cite_ref-Peptic_Ulcer_16-3" class="reference"><a href="#cite_note-Peptic_Ulcer-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> </p><p>An <a href="/wiki/Esophagogastroduodenoscopy" title="Esophagogastroduodenoscopy">esophagogastroduodenoscopy</a> (EGD), a form of <a href="/wiki/Endoscopy" title="Endoscopy">endoscopy</a>, also known as a <a href="/wiki/Gastroscopy" class="mw-redirect" title="Gastroscopy">gastroscopy</a>, is carried out on people in whom a peptic ulcer is suspected. It is also the gold standard of diagnosis for peptic ulcer disease.<sup id="cite_ref-Angel_2017_15-11" class="reference"><a href="#cite_note-Angel_2017-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> By direct visual identification, the location and severity of an ulcer can be described. Moreover, if no ulcer is present, EGD can often provide an alternative diagnosis. </p><p>One of the reasons that <a href="/wiki/Blood_test" title="Blood test">blood tests</a> are not reliable for accurate peptic ulcer diagnosis on their own is their inability to differentiate between past exposure to the bacteria and current infection. Additionally, a false negative result is possible with a blood test if the person has recently been taking certain drugs, such as <a href="/wiki/Antibiotics" class="mw-redirect" title="Antibiotics">antibiotics</a> or <a href="/wiki/Proton-pump_inhibitor" title="Proton-pump inhibitor">proton-pump inhibitors</a>.<sup id="cite_ref-37" class="reference"><a href="#cite_note-37"><span class="cite-bracket">[</span>36<span class="cite-bracket">]</span></a></sup> </p><p>The diagnosis of <i><a href="/wiki/Helicobacter_pylori" title="Helicobacter pylori">Helicobacter pylori</a></i> can be made by: </p> <ul><li><a href="/wiki/Urea_breath_test" title="Urea breath test">Urea breath test</a> (noninvasive and does not require EGD);</li> <li>Direct culture from an EGD biopsy specimen; this is difficult and can be expensive. Most labs are not set up to perform <i>H. pylori</i> cultures;</li> <li>Direct detection of <a href="/wiki/Urease" title="Urease">urease</a> activity in a biopsy specimen by <a href="/wiki/Rapid_urease_test" title="Rapid urease test">rapid urease test</a>;<sup id="cite_ref-Angel_2017_15-12" class="reference"><a href="#cite_note-Angel_2017-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup></li> <li>Measurement of <a href="/wiki/Antibody" title="Antibody">antibody</a> levels in the blood (does not require EGD). It is still somewhat controversial whether a positive antibody without EGD is enough to warrant eradication therapy;</li> <li>Stool <a href="/wiki/Antigen" title="Antigen">antigen</a> test;<sup id="cite_ref-Stenstrom2008_38-0" class="reference"><a href="#cite_note-Stenstrom2008-38"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup></li> <li>Histological examination and staining of an EGD biopsy.</li></ul> <p>The breath test uses radioactive <a href="/wiki/Carbon" title="Carbon">carbon</a> to detect H. pylori.<sup id="cite_ref-39" class="reference"><a href="#cite_note-39"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup> To perform this exam, the person is asked to drink a tasteless liquid that contains the carbon as part of the substance that the bacteria breaks down. After an hour, the person is asked to blow into a sealed bag. If the person is infected with <i>H. pylori</i>, the breath sample will contain radioactive <a href="/wiki/Carbon_dioxide" title="Carbon dioxide">carbon dioxide</a>. This test provides the advantage of being able to monitor the response to treatment used to kill the bacteria. </p><p>The possibility of other causes of ulcers, notably <a href="/wiki/Malignancy" title="Malignancy">malignancy</a> (<a href="/wiki/Gastric_cancer" class="mw-redirect" title="Gastric cancer">gastric cancer</a>), needs to be kept in mind. This is especially true in ulcers of the <a href="/wiki/Greater_curvature_of_the_stomach" class="mw-redirect" title="Greater curvature of the stomach">greater curvature of the stomach</a>; most are also a consequence of chronic <i>H. pylori</i> infection. </p><p>If a peptic ulcer perforates, air will leak from inside the gastrointestinal tract (which always contains some air) to the peritoneal cavity (which normally never contains air). This leads to "free gas" within the peritoneal cavity. If the person stands, as when having a chest X-ray, the gas will float to a position underneath the diaphragm. Therefore, gas in the peritoneal cavity, shown on an erect chest X-ray or supine lateral abdominal X-ray, is an omen of perforated peptic ulcer disease. </p> <div class="mw-heading mw-heading3"><h3 id="Classification">Classification</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Peptic_ulcer_disease&action=edit&section=10" title="Edit section: Classification"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Peptic_ulcer.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/7/74/Peptic_ulcer.svg/260px-Peptic_ulcer.svg.png" decoding="async" width="260" height="159" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/7/74/Peptic_ulcer.svg/390px-Peptic_ulcer.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/7/74/Peptic_ulcer.svg/520px-Peptic_ulcer.svg.png 2x" data-file-width="512" data-file-height="313" /></a><figcaption><div><ol><li>Esophagus</li><li>Stomach</li><li>Ulcers</li><li>Duodenum</li><li>Mucosa</li><li>Submucosa</li><li>Muscle</li></ol></div></figcaption></figure> <p>Peptic ulcers are a form of <a href="/wiki/Acid_peptic_diseases" title="Acid peptic diseases">acid–peptic disorder</a>. Peptic ulcers can be classified according to their location and other factors. </p> <div class="mw-heading mw-heading4"><h4 id="By_location">By location</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Peptic_ulcer_disease&action=edit&section=11" title="Edit section: By location"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/Duodenum" title="Duodenum">Duodenum</a> (called duodenal ulcer)</li> <li><a href="/wiki/Esophagus" title="Esophagus">Esophagus</a> (called esophageal ulcer)</li> <li><a href="/wiki/Stomach" title="Stomach">Stomach</a> (called gastric ulcer)</li> <li><a href="/wiki/Meckel%27s_diverticulum" title="Meckel's diverticulum">Meckel's diverticulum</a> (called Meckel's diverticulum ulcer; is very tender with palpation)</li></ul> <div class="mw-heading mw-heading4"><h4 id="Modified_Johnson">Modified Johnson</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Peptic_ulcer_disease&action=edit&section=12" title="Edit section: Modified Johnson"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li>Type <b>I</b>: Ulcer along the body of the stomach, most often along the lesser curve at incisura angularis along the locus minoris resistantiae. Not associated with acid hypersecretion.</li> <li>Type <b>II</b>: Ulcer in the body in combination with duodenal ulcers. Associated with acid oversecretion.</li> <li>Type <b>III</b>: In the pyloric channel within 3 cm of pylorus. Associated with acid oversecretion.</li> <li>Type <b>IV</b>: Proximal gastroesophageal ulcer.</li> <li>Type <b>V</b>: Can occur throughout the stomach. Associated with the chronic use of NSAIDs (such as <a href="/wiki/Ibuprofen" title="Ibuprofen">ibuprofen</a>).</li></ul> <div class="mw-heading mw-heading3"><h3 id="Macroscopic_appearance">Macroscopic appearance</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Peptic_ulcer_disease&action=edit&section=13" title="Edit section: Macroscopic appearance"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Benign_gastric_ulcer_1.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/f/f1/Benign_gastric_ulcer_1.jpg/260px-Benign_gastric_ulcer_1.jpg" decoding="async" width="260" height="265" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/f/f1/Benign_gastric_ulcer_1.jpg/390px-Benign_gastric_ulcer_1.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/f/f1/Benign_gastric_ulcer_1.jpg 2x" data-file-width="400" data-file-height="408" /></a><figcaption>A benign gastric ulcer (from the antrum) of a <a href="/wiki/Gastrectomy" title="Gastrectomy">gastrectomy</a> specimen.</figcaption></figure> <p>Gastric ulcers are most often localized on the lesser curvature of the stomach. The ulcer is a round to oval parietal defect ("hole"), 2–4 cm diameter, with a smooth base and perpendicular borders. These borders are not elevated or irregular in the acute form of peptic ulcer, and regular but with elevated borders and inflammatory surrounding in the chronic form. In the ulcerative form of gastric cancer, the borders are irregular. Surrounding mucosa may present radial folds, as a consequence of the parietal scarring.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (July 2022)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading3"><h3 id="Microscopic_appearance">Microscopic appearance</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Peptic_ulcer_disease&action=edit&section=14" title="Edit section: Microscopic appearance"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Erosive_gastric_ulcer.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/c/cb/Erosive_gastric_ulcer.jpg/260px-Erosive_gastric_ulcer.jpg" decoding="async" width="260" height="195" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/c/cb/Erosive_gastric_ulcer.jpg/390px-Erosive_gastric_ulcer.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/c/cb/Erosive_gastric_ulcer.jpg/520px-Erosive_gastric_ulcer.jpg 2x" data-file-width="2048" data-file-height="1536" /></a><figcaption>Micrograph showing erosive gastric ulcer. (H&E stain)</figcaption></figure> <p>A gastric peptic ulcer is a mucosal perforation that penetrates the <a href="/wiki/Muscularis_mucosae" title="Muscularis mucosae">muscularis mucosae</a> and lamina propria, usually produced by acid-pepsin aggression. Ulcer margins are perpendicular and present chronic gastritis. During the active phase, the base of the ulcer shows four zones: fibrinoid necrosis, inflammatory exudate, granulation tissue and fibrous tissue. The fibrous base of the ulcer may contain vessels with thickened wall or with thrombosis.<sup id="cite_ref-pathologyatlas_40-0" class="reference"><a href="#cite_note-pathologyatlas-40"><span class="cite-bracket">[</span>39<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Differential_diagnosis">Differential diagnosis</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Peptic_ulcer_disease&action=edit&section=15" title="Edit section: Differential diagnosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Conditions that may appear similar include: </p> <style data-mw-deduplicate="TemplateStyles:r1184024115">.mw-parser-output .div-col{margin-top:0.3em;column-width:30em}.mw-parser-output .div-col-small{font-size:90%}.mw-parser-output .div-col-rules{column-rule:1px solid #aaa}.mw-parser-output .div-col dl,.mw-parser-output .div-col ol,.mw-parser-output .div-col ul{margin-top:0}.mw-parser-output .div-col li,.mw-parser-output .div-col dd{page-break-inside:avoid;break-inside:avoid-column}</style><div class="div-col" style="column-width: 30em;"> <ul><li><a href="/wiki/Gastritis" title="Gastritis">Gastritis</a></li> <li><a href="/wiki/Stomach_cancer" title="Stomach cancer">Stomach cancer</a></li> <li><a href="/wiki/Gastroesophageal_reflux_disease" title="Gastroesophageal reflux disease">Gastroesophageal reflux disease</a></li> <li><a href="/wiki/Pancreatitis" title="Pancreatitis">Pancreatitis</a></li> <li><a href="/wiki/Congestive_hepatopathy" title="Congestive hepatopathy">Hepatic congestion</a></li> <li><a href="/wiki/Cholecystitis" title="Cholecystitis">Cholecystitis</a></li> <li><a href="/wiki/Biliary_colic" title="Biliary colic">Biliary colic</a></li> <li><a href="/wiki/Myocardial_infarction" title="Myocardial infarction">Inferior myocardial infarction</a></li> <li><a href="/wiki/Referred_pain" title="Referred pain">Referred pain</a> (<a href="/wiki/Pleurisy" title="Pleurisy">pleurisy</a>, <a href="/wiki/Pericarditis" title="Pericarditis">pericarditis</a>)</li> <li><a href="/wiki/Superior_mesenteric_artery_syndrome" title="Superior mesenteric artery syndrome">Superior mesenteric artery syndrome</a></li></ul> </div> <div class="mw-heading mw-heading2"><h2 id="Prevention">Prevention</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Peptic_ulcer_disease&action=edit&section=16" title="Edit section: Prevention"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Prevention of peptic ulcer disease for those who are taking NSAIDs (with low cardiovascular risk) can be achieved by adding a <a href="/wiki/Proton_pump_inhibitor" class="mw-redirect" title="Proton pump inhibitor">proton pump inhibitor</a> (PPI), an <a href="/wiki/H2_antagonist" class="mw-redirect" title="H2 antagonist">H2 antagonist</a>, or <a href="/wiki/Misoprostol" title="Misoprostol">misoprostol</a>.<sup id="cite_ref-Angel_2017_15-13" class="reference"><a href="#cite_note-Angel_2017-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> NSAIDs of the COX-2 inhibitors type may reduce the rate of ulcers when compared to non-selective NSAIDs.<sup id="cite_ref-Angel_2017_15-14" class="reference"><a href="#cite_note-Angel_2017-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> PPI is the most popular agent in peptic ulcer prevention.<sup id="cite_ref-Angel_2017_15-15" class="reference"><a href="#cite_note-Angel_2017-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> However, there is no evidence that H2 antagonists can prevent stomach bleeding for those taking NSAIDs.<sup id="cite_ref-Angel_2017_15-16" class="reference"><a href="#cite_note-Angel_2017-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> Although misoprostol is effective in preventing peptic ulcer, its properties of promoting abortion and causing gastrointestinal distress limit its use.<sup id="cite_ref-Angel_2017_15-17" class="reference"><a href="#cite_note-Angel_2017-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> For those with high cardiovascular risk, naproxen with PPI can be a useful choice.<sup id="cite_ref-Angel_2017_15-18" class="reference"><a href="#cite_note-Angel_2017-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> Otherwise, low-dose aspirin, celecoxib, and PPI can also be used.<sup id="cite_ref-Angel_2017_15-19" class="reference"><a href="#cite_note-Angel_2017-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Management">Management</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Peptic_ulcer_disease&action=edit&section=17" title="Edit section: Management"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Antisectetory_drugs.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/1/1a/Antisectetory_drugs.jpg/220px-Antisectetory_drugs.jpg" decoding="async" width="220" height="252" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/1/1a/Antisectetory_drugs.jpg/330px-Antisectetory_drugs.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/1/1a/Antisectetory_drugs.jpg/440px-Antisectetory_drugs.jpg 2x" data-file-width="2269" data-file-height="2597" /></a><figcaption>Peptic ulcer treatment: pharmacology of drugs</figcaption></figure> <div class="mw-heading mw-heading3"><h3 id="Eradication_therapy">Eradication therapy</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Peptic_ulcer_disease&action=edit&section=18" title="Edit section: Eradication therapy"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Once the diagnosis of <i>H. pylori</i> is confirmed, the first-line treatment would be a triple regimen in which <a href="/wiki/Pantoprazole" title="Pantoprazole">pantoprazole</a> and <a href="/wiki/Clarithromycin" title="Clarithromycin">clarithromycin</a> are combined with either <a href="/wiki/Amoxicillin" title="Amoxicillin">amoxicillin</a> or <a href="/wiki/Metronidazole" title="Metronidazole">metronidazole</a>. This treatment regimen can be given for 7–14 days. However, its effectiveness in eradicating <i>H. pylori</i> has been reducing from 90% to 70%. However, the rate of eradication can be increased by doubling the dosage of pantoprazole or increasing the duration of treatment to 14 days. Quadruple therapy (pantoprazole, clarithromycin, amoxicillin, and metronidazole) can also be used. The quadruple therapy can achieve an eradication rate of 90%. If the clarithromycin resistance rate is higher than 15% in an area, the usage of clarithromycin should be abandoned. Instead, <a href="/wiki/Bismuth" title="Bismuth">bismuth</a>-containing quadruple therapy can be used (pantoprazole, bismuth citrate, <a href="/wiki/Tetracycline" title="Tetracycline">tetracycline</a>, and metronidazole) for 14 days. The bismuth therapy can also achieve an eradication rate of 90% and can be used as second-line therapy when the first-line triple-regimen therapy has failed. </p> <div class="mw-heading mw-heading3"><h3 id="NSAIDs-induced_ulcers">NSAIDs-induced ulcers</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Peptic_ulcer_disease&action=edit&section=19" title="Edit section: NSAIDs-induced ulcers"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>NSAID-associated ulcers heal in six to eight weeks provided the NSAIDs are withdrawn with the introduction of <a href="/wiki/Proton_pump_inhibitor" class="mw-redirect" title="Proton pump inhibitor">proton pump inhibitors</a> (PPI).<sup id="cite_ref-Angel_2017_15-20" class="reference"><a href="#cite_note-Angel_2017-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Bleeding">Bleeding</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Peptic_ulcer_disease&action=edit&section=20" title="Edit section: Bleeding"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>For those with bleeding peptic ulcers, <a href="/wiki/Fluid_replacement" title="Fluid replacement">fluid replacement</a> with <a href="/wiki/Crystalloid_solution" class="mw-redirect" title="Crystalloid solution">crystalloids</a> is sometimes given to maintain volume in the blood vessels. Maintaining haemoglobin at greater than 7 g/dL (70 g/L) through restrictive blood transfusion has been associated with reduced rate of death. <a href="/wiki/Glasgow-Blatchford_score" title="Glasgow-Blatchford score">Glasgow-Blatchford score</a> is used to determine whether a person should be treated inside a hospital or as an outpatient. <a href="/wiki/Intravenous" class="mw-redirect" title="Intravenous">Intravenous</a> PPIs can suppress stomach bleeding more quickly than oral ones. A neutral stomach pH is required to keep platelets in place and prevent clot lysis. <a href="/wiki/Tranexamic_acid" title="Tranexamic acid">Tranexamic acid</a> and <a href="/wiki/Antifibrinolytic" title="Antifibrinolytic">antifibrinolytic</a> agents are not useful in treating peptic ulcer disease.<sup id="cite_ref-Angel_2017_15-21" class="reference"><a href="#cite_note-Angel_2017-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> </p><p>Early endoscopic therapy can help to stop bleeding by using <a href="/wiki/Cautery" class="mw-redirect" title="Cautery">cautery</a>, <a href="/wiki/Endoclip" title="Endoclip">endoclip</a>, or <a href="/wiki/Epinephrine" class="mw-redirect" title="Epinephrine">epinephrine</a> injection. Treatment is indicated if there is active bleeding in the stomach, visible vessels, or an adherent clot. Endoscopy is also helpful in identifying people who are suitable for hospital discharge. <a href="/wiki/Prokinetic_agent" title="Prokinetic agent">Prokinetic agents</a> such as <a href="/wiki/Erythromycin" title="Erythromycin">erythromycin</a> and <a href="/wiki/Metoclopramide" title="Metoclopramide">metoclopramide</a> can be given before endoscopy to improve endoscopic view. Either high- or low-dose PPIs are equally effective in reducing bleeding after endoscopy. High-dose intravenous PPI is defined as a bolus dose of 80 mg followed by an infusion of 8 mg per hour for 72 hours—in other words, the continuous infusion of PPI of greater than 192 mg per day. Intravenous PPI can be changed to oral once there is no high risk of rebleeding from peptic ulcer.<sup id="cite_ref-Angel_2017_15-22" class="reference"><a href="#cite_note-Angel_2017-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> </p><p>For those with <a href="/wiki/Hypovolemic_shock" title="Hypovolemic shock">hypovolemic shock</a> and ulcer size of greater than 2 cm, there is a high chance that the endoscopic treatment would fail. Therefore, surgery and angiographic embolism are reserved for these complicated cases. However, there is a higher rate of complication for those who underwent surgery to patch the stomach bleeding site when compared to repeated endoscopy. <a href="/wiki/Angiographic_embolisation" class="mw-redirect" title="Angiographic embolisation">Angiographic embolisation</a> has a higher rebleeding rate but a similar rate of death to surgery.<sup id="cite_ref-Angel_2017_15-23" class="reference"><a href="#cite_note-Angel_2017-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Anticoagulants">Anticoagulants</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Peptic_ulcer_disease&action=edit&section=21" title="Edit section: Anticoagulants"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>According to expert opinion, for those who are already on anticoagulants, the <a href="/wiki/International_normalized_ratio" class="mw-redirect" title="International normalized ratio">international normalized ratio</a> (INR) should be kept at 1.5. For aspirin users who required endoscopic treatment for bleeding peptic ulcer, there is two times increased risk of rebleeding but with ten times reduced risk of death at eight weeks following the resumption of aspirin. For those who were on double antiplatelet agents for indwelling stent in blood vessels, both antiplatelet agents should not be stopped because there is a high risk of stent thrombosis. For those who were under <a href="/wiki/Warfarin" title="Warfarin">warfarin</a> treatment, <a href="/wiki/Fresh_frozen_plasma" title="Fresh frozen plasma">fresh frozen plasma</a> (FFP), vitamin K, prothrombin complex concentrates, or recombinant factor VIIa can be given to reverse the effect of warfarin. High doses of vitamin K should be avoided to reduce the time for rewarfarinisation once the stomach bleeding has stopped. Prothrombin complex concentrates are preferred for severe bleeding. Recombinant factor VIIa is reserved for life-threatening bleeding because of its high risk of thromboembolism.<sup id="cite_ref-Angel_2017_15-24" class="reference"><a href="#cite_note-Angel_2017-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Anticoagulant#Directly_acting_oral_anticoagulants" title="Anticoagulant">Direct oral anticoagulants</a> (DOAC) are recommended instead of warfarin as they are more effective in preventing thromboembolism. In case of bleeding caused by DOAC, <a href="/wiki/Activated_carbon" title="Activated carbon">activated charcoal</a> within four hours is the antidote of choice. </p> <div class="mw-heading mw-heading2"><h2 id="Epidemiology">Epidemiology</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Peptic_ulcer_disease&action=edit&section=22" title="Edit section: Epidemiology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Peptic_ulcer_disease_world_map-Deaths_per_million_persons-WHO2012.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/a/a5/Peptic_ulcer_disease_world_map-Deaths_per_million_persons-WHO2012.svg/290px-Peptic_ulcer_disease_world_map-Deaths_per_million_persons-WHO2012.svg.png" decoding="async" width="290" height="128" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/a/a5/Peptic_ulcer_disease_world_map-Deaths_per_million_persons-WHO2012.svg/435px-Peptic_ulcer_disease_world_map-Deaths_per_million_persons-WHO2012.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/a/a5/Peptic_ulcer_disease_world_map-Deaths_per_million_persons-WHO2012.svg/580px-Peptic_ulcer_disease_world_map-Deaths_per_million_persons-WHO2012.svg.png 2x" data-file-width="940" data-file-height="415" /></a><figcaption>Deaths from peptic ulcer disease per million persons in 2012 <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1184024115" /><div class="div-col div-col-small" style="column-width: 10em;"><style data-mw-deduplicate="TemplateStyles:r981673959">.mw-parser-output .legend{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .legend-color{display:inline-block;min-width:1.25em;height:1.25em;line-height:1.25;margin:1px 0;text-align:center;border:1px solid black;background-color:transparent;color:black}.mw-parser-output .legend-text{}</style><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#ffff20; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 0-7</div><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959" /><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#ffe820; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 8-11</div><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959" /><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#ffd820; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 12-16</div><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959" /><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#ffc020; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 17-19</div><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959" /><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#ffa020; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 20-25</div><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959" /><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#ff9a20; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 26-32</div><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959" /><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#f08015; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 33-40</div><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959" /><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#e06815; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 41-53</div><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959" /><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#d85010; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 54-72</div><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959" /><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#d02010; color:white;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 73-132</div></div></figcaption></figure> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Peptic_ulcer_disease_world_map_-_DALY_-_WHO2004.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/d/d0/Peptic_ulcer_disease_world_map_-_DALY_-_WHO2004.svg/290px-Peptic_ulcer_disease_world_map_-_DALY_-_WHO2004.svg.png" decoding="async" width="290" height="128" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/d/d0/Peptic_ulcer_disease_world_map_-_DALY_-_WHO2004.svg/435px-Peptic_ulcer_disease_world_map_-_DALY_-_WHO2004.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/d/d0/Peptic_ulcer_disease_world_map_-_DALY_-_WHO2004.svg/580px-Peptic_ulcer_disease_world_map_-_DALY_-_WHO2004.svg.png 2x" data-file-width="940" data-file-height="415" /></a><figcaption><a href="/wiki/Disability-adjusted_life_year" title="Disability-adjusted life year">Disability-adjusted life year</a> for peptic ulcer disease per 100,000 inhabitants in 2004.<sup id="cite_ref-41" class="reference"><a href="#cite_note-41"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1184024115" /><div class="div-col div-col-small" style="column-width: 10em;"> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959" /><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#b3b3b3; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> no data</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959" /><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#ffff65; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> less than 20</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959" /><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#fff200; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 20–40</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959" /><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#ffdc00; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 40–60</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959" /><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#ffc600; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 60–80</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959" /><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#ffb000; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 80–100</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959" /><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#ff9a00; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 100–120</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959" /><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#ff8400; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 120–140</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959" /><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#ff6e00; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 140–160</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959" /><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#ff5800; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 160–180</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959" /><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#ff4200; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 180–200</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959" /><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#ff2c00; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 200–220</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959" /><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#cb0000; color:white;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> more than 220</div> </div></figcaption></figure> <p>The lifetime risk for developing a peptic ulcer is approximately 5% to 10%<sup id="cite_ref-Snow2008_9-1" class="reference"><a href="#cite_note-Snow2008-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Angel_2017_15-25" class="reference"><a href="#cite_note-Angel_2017-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> with the rate of 0.1% to 0.3% per year.<sup id="cite_ref-Angel_2017_15-26" class="reference"><a href="#cite_note-Angel_2017-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> Peptic ulcers resulted in 301,000 deaths in 2013, down from 327,000 in 1990.<sup id="cite_ref-GDB2013_10-1" class="reference"><a href="#cite_note-GDB2013-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> </p><p>In Western countries, the percentage of people with <i>H. pylori</i> infections roughly matches age (i.e., 20% at age 20, 30% at age 30, 80% at age 80, etc.). Prevalence is higher in third world countries, where it is estimated at 70% of the population, whereas developed countries show a maximum of a 40% ratio. Overall, <i>H. pylori</i> infections show a worldwide decrease, more so in developed countries. Transmission occurs via food, contaminated groundwater, or human saliva (such as from kissing or sharing food utensils).<sup id="cite_ref-pmid11218379_42-0" class="reference"><a href="#cite_note-pmid11218379-42"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup> </p><p>Peptic ulcer disease had a tremendous effect on morbidity and mortality until the last decades of the 20th century when epidemiological trends started to point to an impressive fall in its incidence. The reason that the rates of peptic ulcer disease decreased is thought to be the development of new effective medication and acid suppressants and the rational use of <a href="/wiki/Nonsteroidal_anti-inflammatory_drug" title="Nonsteroidal anti-inflammatory drug">nonsteroidal anti-inflammatory drugs</a> (NSAIDs).<sup id="cite_ref-Angel_2017_15-27" class="reference"><a href="#cite_note-Angel_2017-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="History">History</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Peptic_ulcer_disease&action=edit&section=23" title="Edit section: History"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1236090951">.mw-parser-output .hatnote{font-style:italic}.mw-parser-output div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">See also: <a href="/wiki/Timeline_of_peptic_ulcer_disease_and_Helicobacter_pylori" title="Timeline of peptic ulcer disease and Helicobacter pylori">Timeline of peptic ulcer disease and Helicobacter pylori</a></div> <p><a href="/wiki/John_Lykoudis" title="John Lykoudis">John Lykoudis</a>, a <a href="/wiki/General_practitioner" title="General practitioner">general practitioner</a> in <a href="/wiki/Greece" title="Greece">Greece</a>, treated people for peptic ulcer disease with <a href="/wiki/Antibiotics" class="mw-redirect" title="Antibiotics">antibiotics</a> beginning in 1958, long before it was commonly recognized that bacteria were a dominant cause for the disease.<sup id="cite_ref-Lykoudis_43-0" class="reference"><a href="#cite_note-Lykoudis-43"><span class="cite-bracket">[</span>42<span class="cite-bracket">]</span></a></sup> </p><p><i><a href="/wiki/Helicobacter_pylori" title="Helicobacter pylori">Helicobacter pylori</a></i> was identified in 1982 by two <a href="/wiki/Australia" title="Australia">Australian</a> scientists, <a href="/wiki/Robin_Warren" title="Robin Warren">Robin Warren</a> and <a href="/wiki/Barry_Marshall" title="Barry Marshall">Barry J. Marshall</a>, as a causative factor for ulcers.<sup id="cite_ref-44" class="reference"><a href="#cite_note-44"><span class="cite-bracket">[</span>43<span class="cite-bracket">]</span></a></sup> In their original paper, Warren and Marshall contended that most gastric ulcers and gastritis were caused by colonization with this bacterium, not by <a href="/wiki/Stress_(medicine)" class="mw-redirect" title="Stress (medicine)">stress</a> or <a href="/wiki/Spicy_food" class="mw-redirect" title="Spicy food">spicy food</a>, as had been assumed before.<sup id="cite_ref-45" class="reference"><a href="#cite_note-45"><span class="cite-bracket">[</span>44<span class="cite-bracket">]</span></a></sup> </p><p>The <i>H. pylori</i> hypothesis was still poorly received,<sup id="cite_ref-46" class="reference"><a href="#cite_note-46"><span class="cite-bracket">[</span>45<span class="cite-bracket">]</span></a></sup> so in an act of <a href="/wiki/Self-experimentation" title="Self-experimentation">self-experimentation</a> Marshall drank a <a href="/wiki/Petri_dish" title="Petri dish">Petri dish</a> containing a culture of organisms extracted from a person with an ulcer and five days later developed gastritis. His symptoms disappeared after two weeks, but he took antibiotics to kill the remaining bacteria at the urging of his wife, since <a href="/wiki/Halitosis" class="mw-redirect" title="Halitosis">halitosis</a> is one of the symptoms of infection.<sup id="cite_ref-mja_47-0" class="reference"><a href="#cite_note-mja-47"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup> This experiment was published in 1984 in the <i><a href="/wiki/Australian_Medical_Journal" class="mw-redirect" title="Australian Medical Journal">Australian Medical Journal</a></i> and is among the most cited articles from the journal. </p><p>In 1997, the <a href="/wiki/Centers_for_Disease_Control_and_Prevention" title="Centers for Disease Control and Prevention">Centers for Disease Control and Prevention</a>, with other government agencies, academic institutions, and industry, launched a national education campaign to inform health care providers and consumers about the link between <i>H. pylori</i> and ulcers. This campaign reinforced the news that ulcers are a curable infection and that health can be greatly improved and money saved by disseminating information about <i>H. pylori</i>.<sup id="cite_ref-48" class="reference"><a href="#cite_note-48"><span class="cite-bracket">[</span>47<span class="cite-bracket">]</span></a></sup> </p><p>In 2005, the <a href="/wiki/Karolinska_Institutet" class="mw-redirect" title="Karolinska Institutet">Karolinska Institute in Stockholm</a> awarded the <a href="/wiki/Nobel_Prize_in_Physiology_or_Medicine" title="Nobel Prize in Physiology or Medicine">Nobel Prize in Physiology or Medicine</a> to Marshall and his long-time collaborator Warren "for their discovery of the bacterium <i>Helicobacter pylori</i> and its role in <a href="/wiki/Gastritis" title="Gastritis">gastritis</a> and peptic ulcer disease." Marshall continues research related to <i>H. pylori</i> and runs a molecular biology lab at <a href="/wiki/University_of_Western_Australia" title="University of Western Australia">UWA</a> in Perth, Western Australia. </p><p>A 1998 New England Medical Journal study found that <a href="/wiki/Mastic_gum" class="mw-redirect" title="Mastic gum">mastic gum</a>, a tree resin extract, actively eliminated the <i>H. pylori</i> bacteria.<sup id="cite_ref-pmid9874617_49-0" class="reference"><a href="#cite_note-pmid9874617-49"><span class="cite-bracket">[</span>48<span class="cite-bracket">]</span></a></sup> However, multiple subsequent studies (in mice and in vivo) have found no effect of using mastic gum on reducing <i>H. pylori</i> levels.<sup id="cite_ref-pmid12562704_50-0" class="reference"><a href="#cite_note-pmid12562704-50"><span class="cite-bracket">[</span>49<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-pmid12888582_51-0" class="reference"><a href="#cite_note-pmid12888582-51"><span class="cite-bracket">[</span>50<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Notes">Notes</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Peptic_ulcer_disease&action=edit&section=24" title="Edit section: Notes"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-references-wrap"><ol class="references"> <li id="cite_note-34"><span class="mw-cite-backlink"><b><a href="#cite_ref-34">^</a></b></span> <span class="reference-text">Sonnenberg in his study cautiously concludes that, among other potential factors that were found to correlate to ulcer healing, "moderate alcohol intake might [also] favor ulcer healing." (p. 1066)</span> </li> </ol></div> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Peptic_ulcer_disease&action=edit&section=25" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-Na2011-1"><span class="mw-cite-backlink">^ <a href="#cite_ref-Na2011_1-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Na2011_1-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-Na2011_1-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-Na2011_1-3"><sup><i><b>d</b></i></sup></a> <a href="#cite_ref-Na2011_1-4"><sup><i><b>e</b></i></sup></a> <a href="#cite_ref-Na2011_1-5"><sup><i><b>f</b></i></sup></a> <a href="#cite_ref-Na2011_1-6"><sup><i><b>g</b></i></sup></a> <a href="#cite_ref-Na2011_1-7"><sup><i><b>h</b></i></sup></a> <a href="#cite_ref-Na2011_1-8"><sup><i><b>i</b></i></sup></a> <a href="#cite_ref-Na2011_1-9"><sup><i><b>j</b></i></sup></a> <a href="#cite_ref-Na2011_1-10"><sup><i><b>k</b></i></sup></a> <a href="#cite_ref-Na2011_1-11"><sup><i><b>l</b></i></sup></a> <a href="#cite_ref-Na2011_1-12"><sup><i><b>m</b></i></sup></a> <a href="#cite_ref-Na2011_1-13"><sup><i><b>n</b></i></sup></a> <a href="#cite_ref-Na2011_1-14"><sup><i><b>o</b></i></sup></a> <a href="#cite_ref-Na2011_1-15"><sup><i><b>p</b></i></sup></a> <a href="#cite_ref-Na2011_1-16"><sup><i><b>q</b></i></sup></a> <a href="#cite_ref-Na2011_1-17"><sup><i><b>r</b></i></sup></a> <a href="#cite_ref-Na2011_1-18"><sup><i><b>s</b></i></sup></a> <a href="#cite_ref-Na2011_1-19"><sup><i><b>t</b></i></sup></a></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite id="CITEREFNajm2011" class="citation journal cs1">Najm WI (September 2011). 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Retrieved <span class="nowrap">26 August</span> 2007</span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=ATLAS+OF+PATHOLOGY&rft_id=http%3A%2F%2Fwww.pathologyatlas.ro%2Fchronic-peptic-ulcer.php&rfr_id=info%3Asid%2Fen.wikipedia.org%3APeptic+ulcer+disease" class="Z3988"></span></span> </li> <li id="cite_note-41"><span class="mw-cite-backlink"><b><a href="#cite_ref-41">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222" /><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html">"WHO Disease and injury country estimates"</a>. <i>World Health Organization</i>. 2009. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20091111101009/http://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html">Archived</a> from the original on 11 November 2009<span class="reference-accessdate">. Retrieved <span class="nowrap">11 November</span> 2009</span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=World+Health+Organization&rft.atitle=WHO+Disease+and+injury+country+estimates&rft.date=2009&rft_id=https%3A%2F%2Fwww.who.int%2Fhealthinfo%2Fglobal_burden_disease%2Festimates_country%2Fen%2Findex.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3APeptic+ulcer+disease" class="Z3988"></span></span> </li> <li id="cite_note-pmid11218379-42"><span class="mw-cite-backlink"><b><a href="#cite_ref-pmid11218379_42-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222" /><cite id="CITEREFBrown2000" class="citation journal cs1">Brown LM (2000). <a rel="nofollow" class="external text" href="https://doi.org/10.1093%2Foxfordjournals.epirev.a018040">"Helicobacter pylori: epidemiology and routes of transmission"</a>. <i>Epidemiologic Reviews</i>. <b>22</b> (2): <span class="nowrap">283–</span>97. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.1093%2Foxfordjournals.epirev.a018040">10.1093/oxfordjournals.epirev.a018040</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/11218379">11218379</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Epidemiologic+Reviews&rft.atitle=Helicobacter+pylori%3A+epidemiology+and+routes+of+transmission&rft.volume=22&rft.issue=2&rft.pages=%3Cspan+class%3D%22nowrap%22%3E283-%3C%2Fspan%3E97&rft.date=2000&rft_id=info%3Adoi%2F10.1093%2Foxfordjournals.epirev.a018040&rft_id=info%3Apmid%2F11218379&rft.aulast=Brown&rft.aufirst=LM&rft_id=https%3A%2F%2Fdoi.org%2F10.1093%252Foxfordjournals.epirev.a018040&rfr_id=info%3Asid%2Fen.wikipedia.org%3APeptic+ulcer+disease" class="Z3988"></span></span> </li> <li id="cite_note-Lykoudis-43"><span class="mw-cite-backlink"><b><a href="#cite_ref-Lykoudis_43-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222" /><cite id="CITEREFRigasPapavasassiliou2002" class="citation book cs1">Rigas B, Papavasassiliou ED (22 May 2002). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=lK4ATW-lQZQC&pg=PA75">"Ch. 7 John Lykoudis. 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John Wiley & Sons. pp. <span class="nowrap">74–</span>88. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-86793-035-1" title="Special:BookSources/978-0-86793-035-1"><bdi>978-0-86793-035-1</bdi></a>. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20160521063535/https://books.google.com/books?id=lK4ATW-lQZQC&pg=PR4">Archived</a> from the original on 21 May 2016.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Ch.+7+John+Lykoudis.+The+general+practitioner+in+Greece+who+in+1958+discovered+the+etiology+of%2C+and+a+treatment+for%2C+peptic+ulcer+disease.&rft.btitle=Helicobacter+pioneers%3A+firsthand+accounts+from+the+scientists+who+discovered+helicobacters%2C+1892%E2%80%931982&rft.pages=%3Cspan+class%3D%22nowrap%22%3E74-%3C%2Fspan%3E88&rft.pub=John+Wiley+%26+Sons&rft.date=2002-05-22&rft.isbn=978-0-86793-035-1&rft.aulast=Rigas&rft.aufirst=Basil&rft.au=Papavasassiliou%2C+Efstathios+D.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DlK4ATW-lQZQC%26pg%3DPA75&rfr_id=info%3Asid%2Fen.wikipedia.org%3APeptic+ulcer+disease" class="Z3988"></span></span> </li> <li id="cite_note-44"><span class="mw-cite-backlink"><b><a href="#cite_ref-44">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222" /><cite id="CITEREFWarrenMarshall1983" class="citation journal cs1">Warren JR, Marshall B (June 1983). 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Or, How To Win a Nobel Prize in One Easy Lesson: Barry Marshall on Being ... Right"</a>. <i>The Wrong Stuff</i>. <a href="/wiki/Slate_(magazine)" title="Slate (magazine)">Slate</a>. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20110805082007/http://www.slate.com/content/slate/blogs/thewrongstuff/2010/09/09/stress_doesn_t_cause_ulers_or_how_to_win_a_nobel_prize_in_one_easy_lesson_barry_marshall_on_being_right.html">Archived</a> from the original on 5 August 2011<span class="reference-accessdate">. Retrieved <span class="nowrap">17 July</span> 2011</span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Wrong+Stuff&rft.atitle=Stress+Doesn%27t+Cause+Ulcers%21+Or%2C+How+To+Win+a+Nobel+Prize+in+One+Easy+Lesson%3A+Barry+Marshall+on+Being+...+Right&rft.date=2010-09-09&rft.aulast=Schulz&rft.aufirst=Kathryn&rft_id=http%3A%2F%2Fwww.slate.com%2Fcontent%2Fslate%2Fblogs%2Fthewrongstuff%2F2010%2F09%2F09%2Fstress_doesn_t_cause_ulers_or_how_to_win_a_nobel_prize_in_one_easy_lesson_barry_marshall_on_being_right.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3APeptic+ulcer+disease" class="Z3988"></span></span> </li> <li id="cite_note-mja-47"><span class="mw-cite-backlink"><b><a href="#cite_ref-mja_47-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222" /><cite id="CITEREFVan_Der_WeydenArmstrongGregory2005" class="citation journal cs1">Van Der Weyden MB, Armstrong RM, Gregory AT (2005). <a rel="nofollow" class="external text" href="http://www.mja.com.au/public/issues/183_11_051205/van11000_fm.html#0_i1091639">"The 2005 Nobel Prize in physiology or medicine"</a>. <i>The Medical Journal of Australia</i>. <b>183</b> (<span class="nowrap">11–</span>12): <span class="nowrap">612–</span>4. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.5694%2Fj.1326-5377.2005.tb00052.x">10.5694/j.1326-5377.2005.tb00052.x</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/16336147">16336147</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:45487832">45487832</a>. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20090627035448/http://www.mja.com.au/public/issues/183_11_051205/van11000_fm.html#0_i1091639">Archived</a> from the original on 27 June 2009.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Medical+Journal+of+Australia&rft.atitle=The+2005+Nobel+Prize+in+physiology+or+medicine&rft.volume=183&rft.issue=%3Cspan+class%3D%22nowrap%22%3E11%E2%80%93%3C%2Fspan%3E12&rft.pages=%3Cspan+class%3D%22nowrap%22%3E612-%3C%2Fspan%3E4&rft.date=2005&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A45487832%23id-name%3DS2CID&rft_id=info%3Apmid%2F16336147&rft_id=info%3Adoi%2F10.5694%2Fj.1326-5377.2005.tb00052.x&rft.aulast=Van+Der+Weyden&rft.aufirst=MB&rft.au=Armstrong%2C+RM&rft.au=Gregory%2C+AT&rft_id=http%3A%2F%2Fwww.mja.com.au%2Fpublic%2Fissues%2F183_11_051205%2Fvan11000_fm.html%230_i1091639&rfr_id=info%3Asid%2Fen.wikipedia.org%3APeptic+ulcer+disease" class="Z3988"></span></span> </li> <li id="cite_note-48"><span class="mw-cite-backlink"><b><a href="#cite_ref-48">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222" /><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.cdc.gov/ulcer/history.htm">"Ulcer, Diagnosis and Treatment - CDC Bacterial, Mycotic Diseases"</a>. Cdc.gov. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20131203231313/http://www.cdc.gov/ulcer/history.htm">Archived</a> from the original on 3 December 2013<span class="reference-accessdate">. Retrieved <span class="nowrap">27 February</span> 2014</span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Ulcer%2C+Diagnosis+and+Treatment+-+CDC+Bacterial%2C+Mycotic+Diseases&rft.pub=Cdc.gov&rft_id=https%3A%2F%2Fwww.cdc.gov%2Fulcer%2Fhistory.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3APeptic+ulcer+disease" class="Z3988"></span></span> </li> <li id="cite_note-pmid9874617-49"><span class="mw-cite-backlink"><b><a href="#cite_ref-pmid9874617_49-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222" /><cite id="CITEREFHuwezThirlwellCockayneAla'Aldeen1998" class="citation journal cs1">Huwez FU, Thirlwell D, Cockayne A, Ala'Aldeen DA (December 1998). <a rel="nofollow" class="external text" href="http://content.nejm.org/cgi/content/extract/339/26/1946">"Mastic gum kills Helicobacter pylori"</a>. <i>The New England Journal of Medicine</i>. <b>339</b> (26): 1946. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.1056%2FNEJM199812243392618">10.1056/NEJM199812243392618</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/9874617">9874617</a>. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20080915121329/http://content.nejm.org/cgi/content/extract/339/26/1946">Archived</a> from the original on 15 September 2008.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+New+England+Journal+of+Medicine&rft.atitle=Mastic+gum+kills+Helicobacter+pylori&rft.volume=339&rft.issue=26&rft.pages=1946&rft.date=1998-12&rft_id=info%3Adoi%2F10.1056%2FNEJM199812243392618&rft_id=info%3Apmid%2F9874617&rft.aulast=Huwez&rft.aufirst=FU&rft.au=Thirlwell%2C+D&rft.au=Cockayne%2C+A&rft.au=Ala%27Aldeen%2C+DA&rft_id=http%3A%2F%2Fcontent.nejm.org%2Fcgi%2Fcontent%2Fextract%2F339%2F26%2F1946&rfr_id=info%3Asid%2Fen.wikipedia.org%3APeptic+ulcer+disease" class="Z3988"></span> See also <a rel="nofollow" class="external text" href="http://content.nejm.org/cgi/content/extract/340/7/576">their corrections in the next volume</a> <a rel="nofollow" class="external text" href="https://web.archive.org/web/20081005120756/http://content.nejm.org/cgi/content/extract/340/7/576">Archived</a> 5 October 2008 at the <a href="/wiki/Wayback_Machine" title="Wayback Machine">Wayback Machine</a>.</span> </li> <li id="cite_note-pmid12562704-50"><span class="mw-cite-backlink"><b><a href="#cite_ref-pmid12562704_50-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222" /><cite id="CITEREFLoughlinAla'AldeenJenks2003" class="citation journal cs1">Loughlin MF, Ala'Aldeen DA, Jenks PJ (February 2003). <a rel="nofollow" class="external text" href="https://doi.org/10.1093%2Fjac%2Fdkg057">"Monotherapy with mastic does not eradicate Helicobacter pylori infection from mice"</a>. <i>The Journal of Antimicrobial Chemotherapy</i>. <b>51</b> (2): <span class="nowrap">367–</span>71. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.1093%2Fjac%2Fdkg057">10.1093/jac/dkg057</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/12562704">12562704</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Antimicrobial+Chemotherapy&rft.atitle=Monotherapy+with+mastic+does+not+eradicate+Helicobacter+pylori+infection+from+mice&rft.volume=51&rft.issue=2&rft.pages=%3Cspan+class%3D%22nowrap%22%3E367-%3C%2Fspan%3E71&rft.date=2003-02&rft_id=info%3Adoi%2F10.1093%2Fjac%2Fdkg057&rft_id=info%3Apmid%2F12562704&rft.aulast=Loughlin&rft.aufirst=MF&rft.au=Ala%27Aldeen%2C+DA&rft.au=Jenks%2C+PJ&rft_id=https%3A%2F%2Fdoi.org%2F10.1093%252Fjac%252Fdkg057&rfr_id=info%3Asid%2Fen.wikipedia.org%3APeptic+ulcer+disease" class="Z3988"></span></span> </li> <li id="cite_note-pmid12888582-51"><span class="mw-cite-backlink"><b><a href="#cite_ref-pmid12888582_51-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222" /><cite id="CITEREFBebbBailey-FlitterAla'AldeenAtherton2003" class="citation journal cs1">Bebb JR, Bailey-Flitter N, Ala'Aldeen D, Atherton JC (September 2003). <a rel="nofollow" class="external text" href="https://doi.org/10.1093%2Fjac%2Fdkg366">"Mastic gum has no effect on Helicobacter pylori load in vivo"</a>. <i>The Journal of Antimicrobial Chemotherapy</i>. <b>52</b> (3): <span class="nowrap">522–</span>3. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.1093%2Fjac%2Fdkg366">10.1093/jac/dkg366</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/12888582">12888582</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Antimicrobial+Chemotherapy&rft.atitle=Mastic+gum+has+no+effect+on+Helicobacter+pylori+load+in+vivo&rft.volume=52&rft.issue=3&rft.pages=%3Cspan+class%3D%22nowrap%22%3E522-%3C%2Fspan%3E3&rft.date=2003-09&rft_id=info%3Adoi%2F10.1093%2Fjac%2Fdkg366&rft_id=info%3Apmid%2F12888582&rft.aulast=Bebb&rft.aufirst=JR&rft.au=Bailey-Flitter%2C+N&rft.au=Ala%27Aldeen%2C+D&rft.au=Atherton%2C+JC&rft_id=https%3A%2F%2Fdoi.org%2F10.1093%252Fjac%252Fdkg366&rfr_id=info%3Asid%2Fen.wikipedia.org%3APeptic+ulcer+disease" class="Z3988"></span></span> </li> </ol></div></div> <div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Peptic_ulcer_disease&action=edit&section=26" title="Edit section: External links"><span>edit</span></a><span 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style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">Classification</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><div style="position:relative; float:right; font-size:0.8em;"><a href="https://www.wikidata.org/wiki/Q172941" class="extiw" title="d:Q172941">D</a></div><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-10" title="ICD-10">10</a></b>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/K25">K25</a>–<a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/K27">K27</a></li><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/List_of_ICD-9_codes" title="List of ICD-9 codes">9-CM</a></b>: <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=531">531</a>–<a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=533">533</a></li><li><b><a href="/wiki/Medical_Subject_Headings" title="Medical Subject Headings">MeSH</a></b>: <a rel="nofollow" class="external text" href="https://meshb.nlm.nih.gov/record/ui?ui=D010437">D010437</a></li><li><b><a href="/wiki/Diseases_Database" title="Diseases Database">DiseasesDB</a></b>: <a rel="nofollow" class="external text" href="http://www.diseasesdatabase.com/ddb9819.htm">9819</a></li></ul></div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">External resources</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/MedlinePlus" title="MedlinePlus">MedlinePlus</a></b>: <a rel="nofollow" class="external text" href="https://www.nlm.nih.gov/medlineplus/ency/article/000206.htm">000206</a></li><li><b><a href="/wiki/EMedicine" title="EMedicine">eMedicine</a></b>: <a rel="nofollow" class="external text" href="https://emedicine.medscape.com/med/1776-overview">med/1776</a> <a rel="nofollow" class="external text" href="https://www.emedicine.com/ped/topic2341.htm#">ped/2341</a></li></ul></div></div></td></tr></tbody></table></div> <style data-mw-deduplicate="TemplateStyles:r1235681985">.mw-parser-output .side-box{margin:4px 0;box-sizing:border-box;border:1px solid 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U.S. National Library of Medicine. Archived from <a rel="nofollow" class="external text" href="https://medlineplus.gov/pepticulcer.html">the original</a> on 16 April 2020<span class="reference-accessdate">. Retrieved <span class="nowrap">20 May</span> 2020</span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=MedlinePlus&rft.atitle=Peptic+Ulcer&rft_id=https%3A%2F%2Fmedlineplus.gov%2Fpepticulcer.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3APeptic+ulcer+disease" class="Z3988"></span></li></ul> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374" /><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235" /></div><div role="navigation" class="navbox" aria-labelledby="Pseudomonadota-associated_Gram-negative_bacterial_infections168" style="padding:3px"><table class="nowraplinks hlist mw-collapsible mw-collapsed navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374" /><style 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style="font-size:114%;margin:0 4em"><a href="/wiki/Pseudomonadota" title="Pseudomonadota">Pseudomonadota</a>-associated <a href="/wiki/Gram-negative_bacterial_infection" class="mw-redirect" title="Gram-negative bacterial infection">Gram-negative bacterial infections</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Alphaproteobacteria" title="Alphaproteobacteria">α</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Rickettsiales" title="Rickettsiales">Rickettsiales</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Rickettsiaceae" title="Rickettsiaceae">Rickettsiaceae</a>/<br />(<a href="/wiki/Rickettsiosis" title="Rickettsiosis">Rickettsioses</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Typhus" title="Typhus">Typhus</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Rickettsia_typhi" title="Rickettsia typhi">Rickettsia typhi</a></i> <ul><li><a href="/wiki/Murine_typhus" title="Murine typhus">Murine typhus</a></li></ul></li> <li><i><a href="/wiki/Rickettsia_prowazekii" title="Rickettsia prowazekii">Rickettsia prowazekii</a></i> <ul><li><a href="/wiki/Epidemic_typhus" title="Epidemic typhus">Epidemic typhus</a>, <a href="/wiki/Brill%E2%80%93Zinsser_disease" title="Brill–Zinsser disease">Brill–Zinsser disease</a>, <a href="/wiki/Flying_squirrel_typhus" title="Flying squirrel typhus">Flying squirrel typhus</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Spotted_fever" title="Spotted fever">Spotted<br />fever</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Tick-borne_disease" title="Tick-borne disease">Tick-borne</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Rickettsia_rickettsii" title="Rickettsia rickettsii">Rickettsia rickettsii</a></i> <ul><li><a href="/wiki/Rocky_Mountain_spotted_fever" title="Rocky Mountain spotted fever">Rocky Mountain spotted fever</a></li></ul></li> <li><i><a href="/wiki/Rickettsia_conorii" title="Rickettsia conorii">Rickettsia conorii</a></i> <ul><li><a href="/wiki/Boutonneuse_fever" title="Boutonneuse fever">Boutonneuse fever</a></li></ul></li> <li><i><a href="/wiki/Rickettsia_japonica" title="Rickettsia japonica">Rickettsia japonica</a></i> <ul><li><a href="/wiki/Japanese_spotted_fever" title="Japanese spotted fever">Japanese spotted fever</a></li></ul></li> <li><i><a href="/wiki/Rickettsia_sibirica" title="Rickettsia sibirica">Rickettsia sibirica</a></i> <ul><li><a href="/wiki/North_Asian_tick_typhus" title="North Asian tick typhus">North Asian tick typhus</a></li></ul></li> <li><i><a href="/wiki/Rickettsia_australis" title="Rickettsia australis">Rickettsia australis</a></i> <ul><li><a href="/wiki/Queensland_tick_typhus" title="Queensland tick typhus">Queensland tick typhus</a></li></ul></li> <li><i><a href="/wiki/Rickettsia_honei" title="Rickettsia honei">Rickettsia honei</a></i> <ul><li><a href="/wiki/Flinders_Island_spotted_fever" title="Flinders Island spotted fever">Flinders Island spotted fever</a></li></ul></li> <li><i><a href="/wiki/Rickettsia_africae" title="Rickettsia africae">Rickettsia africae</a></i> <ul><li><a href="/wiki/African_tick_bite_fever" title="African tick bite fever">African tick bite fever</a></li></ul></li> <li><i><a href="/wiki/Rickettsia_parkeri" title="Rickettsia parkeri">Rickettsia parkeri</a></i> <ul><li><a href="/wiki/American_tick_bite_fever" class="mw-redirect" title="American tick bite fever">American tick bite fever</a></li></ul></li> <li><i><a href="/wiki/Rickettsia_aeschlimannii" class="mw-redirect" title="Rickettsia aeschlimannii">Rickettsia aeschlimannii</a></i> <ul><li><a href="/wiki/Rickettsia_aeschlimannii_infection" title="Rickettsia aeschlimannii infection"><i>Rickettsia aeschlimannii</i> infection</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Mite#Clinical_significance" title="Mite">Mite-borne</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Rickettsia_akari" title="Rickettsia akari">Rickettsia akari</a></i> <ul><li><a href="/wiki/Rickettsialpox" title="Rickettsialpox">Rickettsialpox</a></li></ul></li> <li><i><a href="/wiki/Orientia_tsutsugamushi" title="Orientia tsutsugamushi">Orientia tsutsugamushi</a></i> <ul><li><a href="/wiki/Scrub_typhus" title="Scrub typhus">Scrub typhus</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Flea#Fleas_as_a_vector" title="Flea">Flea-borne</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Rickettsia_felis" title="Rickettsia felis">Rickettsia felis</a></i> <ul><li><a href="/wiki/Flea-borne_spotted_fever" title="Flea-borne spotted fever">Flea-borne spotted fever</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Anaplasmataceae" class="mw-redirect" title="Anaplasmataceae">Anaplasmataceae</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Ehrlichiosis" title="Ehrlichiosis">Ehrlichiosis</a>: <i><a href="/wiki/Anaplasma_phagocytophilum" title="Anaplasma phagocytophilum">Anaplasma phagocytophilum</a></i> <ul><li><a href="/wiki/Human_granulocytic_anaplasmosis" title="Human granulocytic anaplasmosis">Human granulocytic anaplasmosis</a>, <a href="/wiki/Anaplasmosis" title="Anaplasmosis">Anaplasmosis</a></li></ul></li> <li><i><a href="/wiki/Ehrlichia_chaffeensis" title="Ehrlichia chaffeensis">Ehrlichia chaffeensis</a></i> <ul><li><a href="/wiki/Human_monocytotropic_ehrlichiosis" title="Human monocytotropic ehrlichiosis">Human monocytotropic ehrlichiosis</a></li></ul></li> <li><i><a href="/wiki/Ehrlichia_ewingii" title="Ehrlichia ewingii">Ehrlichia ewingii</a></i> <ul><li><a href="/wiki/Ehrlichiosis_ewingii_infection" title="Ehrlichiosis ewingii infection">Ehrlichiosis ewingii infection</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Hyphomicrobiales" title="Hyphomicrobiales">Hyphomicrobiales</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Brucellaceae" title="Brucellaceae">Brucellaceae</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Brucella_abortus" title="Brucella abortus">Brucella abortus</a></i> <ul><li><a href="/wiki/Brucellosis" title="Brucellosis">Brucellosis</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Bartonella" title="Bartonella">Bartonellaceae</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Bartonellosis" title="Bartonellosis">Bartonellosis</a>: <i><a href="/wiki/Bartonella_henselae" title="Bartonella henselae">Bartonella henselae</a></i> <ul><li><a href="/wiki/Cat-scratch_disease" title="Cat-scratch disease">Cat-scratch disease</a></li></ul></li> <li><i><a href="/wiki/Bartonella_quintana" title="Bartonella quintana">Bartonella quintana</a></i> <ul><li><a href="/wiki/Trench_fever" title="Trench fever">Trench fever</a></li></ul></li> <li>Either <i>B. henselae</i> or <i>B. quintana</i> <ul><li><a href="/wiki/Bacillary_angiomatosis" title="Bacillary angiomatosis">Bacillary angiomatosis</a></li></ul></li> <li><i><a href="/wiki/Bartonella_bacilliformis" title="Bartonella bacilliformis">Bartonella bacilliformis</a></i> <ul><li><a href="/wiki/Carrion%27s_disease" title="Carrion's disease">Carrion's disease</a>, <a href="/wiki/Verruga_peruana" class="mw-redirect" title="Verruga peruana">Verruga peruana</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Betaproteobacteria" title="Betaproteobacteria">β</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Neisseriaceae" title="Neisseriaceae">Neisseriales</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Maltose" title="Maltose">M+</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Neisseria_meningitidis" title="Neisseria meningitidis">Neisseria meningitidis/meningococcus</a></i> <ul><li><a href="/wiki/Meningococcal_disease" title="Meningococcal disease">Meningococcal disease</a>, <a href="/wiki/Waterhouse%E2%80%93Friderichsen_syndrome" title="Waterhouse–Friderichsen syndrome">Waterhouse–Friderichsen syndrome</a>, <a href="/wiki/Meningococcal_septicaemia" class="mw-redirect" title="Meningococcal septicaemia">Meningococcal septicaemia</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Maltose" title="Maltose">M−</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Neisseria_gonorrhoeae" title="Neisseria gonorrhoeae">Neisseria gonorrhoeae/gonococcus</a></i> <ul><li><a href="/wiki/Gonorrhea" title="Gonorrhea">Gonorrhea</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><span class="nobold"><i>ungrouped:</i></span></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Eikenella_corrodens" title="Eikenella corrodens">Eikenella corrodens</a></i>/<i><a href="/wiki/Kingella_kingae" title="Kingella kingae">Kingella kingae</a></i> <ul><li><a href="/wiki/HACEK_organisms" title="HACEK organisms">HACEK</a></li></ul></li> <li><i><a href="/wiki/Chromobacterium_violaceum" title="Chromobacterium violaceum">Chromobacterium violaceum</a></i> <ul><li><a href="/wiki/Chromobacteriosis_infection" title="Chromobacteriosis infection">Chromobacteriosis infection</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Burkholderiales" title="Burkholderiales">Burkholderiales</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Burkholderia_pseudomallei" title="Burkholderia pseudomallei">Burkholderia pseudomallei</a></i> <ul><li><a href="/wiki/Melioidosis" title="Melioidosis">Melioidosis</a></li></ul></li> <li><i><a href="/wiki/Burkholderia_mallei" title="Burkholderia mallei">Burkholderia mallei</a></i> <ul><li><a href="/wiki/Glanders" title="Glanders">Glanders</a></li></ul></li> <li><i><a href="/wiki/Burkholderia_cepacia_complex" title="Burkholderia cepacia complex">Burkholderia cepacia complex</a></i></li> <li><i><a href="/wiki/Bordetella_pertussis" title="Bordetella pertussis">Bordetella pertussis</a>/<a href="/wiki/Bordetella_parapertussis" title="Bordetella parapertussis">Bordetella parapertussis</a></i> <ul><li><a href="/wiki/Pertussis" class="mw-redirect" title="Pertussis">Pertussis</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Gammaproteobacteria" title="Gammaproteobacteria">γ</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Enterobacteriaceae" title="Enterobacteriaceae">Enterobacteriales</a><br />(<a href="/wiki/Oxidase_test#OX−" title="Oxidase test">OX−</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/MacConkey_agar#Lac+" title="MacConkey agar">Lac+</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Klebsiella_pneumoniae" title="Klebsiella pneumoniae">Klebsiella pneumoniae</a></i> <ul><li><a href="/wiki/Rhinoscleroma" title="Rhinoscleroma">Rhinoscleroma</a>, <a href="/wiki/Pneumonia" title="Pneumonia">Pneumonia</a></li></ul></li> <li><i><a href="/wiki/Klebsiella_granulomatis" title="Klebsiella granulomatis">Klebsiella granulomatis</a></i> <ul><li><a href="/wiki/Granuloma_inguinale" title="Granuloma inguinale">Granuloma inguinale</a></li></ul></li> <li><i><a href="/wiki/Klebsiella_oxytoca" title="Klebsiella oxytoca">Klebsiella oxytoca</a></i></li></ul> <ul><li><i><a href="/wiki/Escherichia_coli" title="Escherichia coli">Escherichia coli</a></i>: <a href="/wiki/Enterotoxigenic_Escherichia_coli" title="Enterotoxigenic Escherichia coli">Enterotoxigenic</a></li> <li><a href="/wiki/Enteroinvasive_Escherichia_coli" title="Enteroinvasive Escherichia coli">Enteroinvasive</a></li> <li><a href="/wiki/Verotoxin-producing_Escherichia_coli" class="mw-redirect" title="Verotoxin-producing Escherichia coli">Enterohemorrhagic</a></li> <li><a href="/wiki/Escherichia_coli_O157:H7" title="Escherichia coli O157:H7">O157:H7</a></li> <li><a href="/wiki/Escherichia_coli_O104:H4" title="Escherichia coli O104:H4">O104:H4</a> <ul><li><a href="/wiki/Hemolytic-uremic_syndrome" class="mw-redirect" title="Hemolytic-uremic syndrome">Hemolytic-uremic syndrome</a></li></ul></li></ul> <ul><li><i><a href="/wiki/Enterobacter_aerogenes" class="mw-redirect" title="Enterobacter aerogenes">Enterobacter aerogenes</a>/<a href="/wiki/Enterobacter_cloacae" title="Enterobacter cloacae">Enterobacter cloacae</a></i></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/MacConkey_agar#Slow" title="MacConkey agar">Slow/weak</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Serratia_marcescens" title="Serratia marcescens">Serratia marcescens</a></i> <ul><li><a href="/wiki/Serratia_infection" class="mw-redirect" title="Serratia infection"><i>Serratia</i> infection</a></li></ul></li> <li><i><a href="/wiki/Citrobacter_koseri" title="Citrobacter koseri">Citrobacter koseri</a></i>/<i><a href="/wiki/Citrobacter_freundii" title="Citrobacter freundii">Citrobacter freundii</a></i></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/MacConkey_agar#Lac−" title="MacConkey agar">Lac−</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Bismuth_sulfite_agar" title="Bismuth sulfite agar">H2S+</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Salmonella_enterica" title="Salmonella enterica">Salmonella enterica</a></i> <ul><li><a href="/wiki/Typhoid_fever" title="Typhoid fever">Typhoid fever</a>, <a href="/wiki/Paratyphoid_fever" title="Paratyphoid fever">Paratyphoid fever</a>, <a href="/wiki/Salmonellosis" title="Salmonellosis">Salmonellosis</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue">H2S−</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Shigella_dysenteriae" title="Shigella dysenteriae">Shigella dysenteriae</a>/<a href="/wiki/Shigella_sonnei" title="Shigella sonnei">sonnei</a>/<a href="/wiki/Shigella_flexneri" title="Shigella flexneri">flexneri</a>/<a href="/wiki/Shigella_boydii" title="Shigella boydii">boydii</a></i> <ul><li><a href="/wiki/Shigellosis" title="Shigellosis">Shigellosis</a>, <a href="/wiki/Bacillary_dysentery" title="Bacillary dysentery">Bacillary dysentery</a></li></ul></li> <li><i><a href="/wiki/Proteus_mirabilis" title="Proteus mirabilis">Proteus mirabilis</a></i>/<i><a href="/wiki/Proteus_vulgaris" title="Proteus vulgaris">Proteus vulgaris</a></i></li> <li><i><a href="/wiki/Yersinia_pestis" title="Yersinia pestis">Yersinia pestis</a></i> <ul><li><a href="/wiki/Plague_(disease)" title="Plague (disease)">Plague</a>/<a href="/wiki/Bubonic_plague" title="Bubonic plague">Bubonic plague</a></li></ul></li> <li><i><a href="/wiki/Yersinia_enterocolitica" title="Yersinia enterocolitica">Yersinia enterocolitica</a></i> <ul><li><a href="/wiki/Yersiniosis" title="Yersiniosis">Yersiniosis</a></li></ul></li> <li><i><a href="/wiki/Yersinia_pseudotuberculosis" title="Yersinia pseudotuberculosis">Yersinia pseudotuberculosis</a></i> <ul><li><a href="/wiki/Far_East_scarlet-like_fever" title="Far East scarlet-like fever">Far East scarlet-like fever</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Pasteurellaceae" title="Pasteurellaceae">Pasteurellales</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><span class="nobold"><i><a href="/wiki/Haemophilus" title="Haemophilus">Haemophilus</a>:</i></span></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Haemophilus_influenzae" title="Haemophilus influenzae">H. influenzae</a></i> <ul><li><a href="/wiki/Haemophilus_meningitis" title="Haemophilus meningitis"><i>Haemophilus</i> meningitis</a></li> <li><a href="/wiki/Brazilian_purpuric_fever" title="Brazilian purpuric fever">Brazilian purpuric fever</a></li></ul></li> <li><i><a href="/wiki/Haemophilus_ducreyi" title="Haemophilus ducreyi">H. ducreyi</a></i> <ul><li><a href="/wiki/Chancroid" title="Chancroid">Chancroid</a></li></ul></li> <li><i><a href="/wiki/Haemophilus_parainfluenzae" title="Haemophilus parainfluenzae">H. parainfluenzae</a></i> <ul><li><a href="/wiki/HACEK_organisms" title="HACEK organisms">HACEK</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><span class="nobold"><i><a href="/wiki/Pasteurella_multocida" title="Pasteurella multocida">Pasteurella multocida</a></i></span></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Pasteurellosis" title="Pasteurellosis">Pasteurellosis</a></li> <li><i><a href="/wiki/Actinobacillus" title="Actinobacillus">Actinobacillus</a></i> <ul><li><a href="/wiki/Actinobacillosis" title="Actinobacillosis">Actinobacillosis</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><span class="nobold"><i><a href="/wiki/Aggregatibacter_actinomycetemcomitans" title="Aggregatibacter actinomycetemcomitans">Aggregatibacter actinomycetemcomitans</a></i></span></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/HACEK_organisms" title="HACEK organisms">HACEK</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Legionellales" title="Legionellales">Legionellales</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Legionella_pneumophila" title="Legionella pneumophila">Legionella pneumophila</a>/<a href="/wiki/Legionella_longbeachae" title="Legionella longbeachae">Legionella longbeachae</a></i> <ul><li><a href="/wiki/Legionnaires%27_disease" title="Legionnaires' disease">Legionnaires' disease</a></li></ul></li> <li><i><a href="/wiki/Coxiella_burnetii" title="Coxiella burnetii">Coxiella burnetii</a></i> <ul><li><a href="/wiki/Q_fever" title="Q fever">Q fever</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Thiotrichales" title="Thiotrichales">Thiotrichales</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Francisella_tularensis" title="Francisella tularensis">Francisella tularensis</a></i> <ul><li><a href="/wiki/Tularemia" title="Tularemia">Tularemia</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Vibrionaceae" title="Vibrionaceae">Vibrionaceae</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Vibrio_cholerae" title="Vibrio cholerae">Vibrio cholerae</a></i> <ul><li><a href="/wiki/Cholera" title="Cholera">Cholera</a></li></ul></li> <li><i><a href="/wiki/Vibrio_vulnificus" title="Vibrio vulnificus">Vibrio vulnificus</a></i></li> <li><i><a href="/wiki/Vibrio_parahaemolyticus" title="Vibrio parahaemolyticus">Vibrio parahaemolyticus</a></i></li> <li><i><a href="/wiki/Vibrio_alginolyticus" title="Vibrio alginolyticus">Vibrio alginolyticus</a></i></li> <li><i><a href="/wiki/Plesiomonas_shigelloides" title="Plesiomonas shigelloides">Plesiomonas shigelloides</a></i></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Pseudomonadales" title="Pseudomonadales">Pseudomonadales</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Pseudomonas_aeruginosa" title="Pseudomonas aeruginosa">Pseudomonas aeruginosa</a></i> <ul><li><a href="/wiki/Pseudomonas_infection" title="Pseudomonas infection"><i>Pseudomonas</i> infection</a></li></ul></li> <li><i><a href="/wiki/Moraxella_catarrhalis" title="Moraxella catarrhalis">Moraxella catarrhalis</a></i></li> <li><i><a href="/wiki/Acinetobacter_baumannii" title="Acinetobacter baumannii">Acinetobacter baumannii</a></i></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Xanthomonadaceae" title="Xanthomonadaceae">Xanthomonadaceae</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Stenotrophomonas_maltophilia" title="Stenotrophomonas maltophilia">Stenotrophomonas maltophilia</a></i></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Cardiobacteriaceae" title="Cardiobacteriaceae">Cardiobacteriaceae</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Cardiobacterium_hominis" title="Cardiobacterium hominis">Cardiobacterium hominis</a></i> <ul><li><a href="/wiki/HACEK_organisms" title="HACEK organisms">HACEK</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Aeromonadales" title="Aeromonadales">Aeromonadales</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Aeromonas_hydrophila" title="Aeromonas hydrophila">Aeromonas hydrophila</a>/<a href="/wiki/Aeromonas_veronii" title="Aeromonas veronii">Aeromonas veronii</a></i> <ul><li><a href="/wiki/Aeromonas_infection" title="Aeromonas infection"><i>Aeromonas</i> infection</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Campylobacterota" title="Campylobacterota">ε</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="Campylobacterales21" scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Campylobacterales" title="Campylobacterales">Campylobacterales</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Campylobacter_jejuni" title="Campylobacter jejuni">Campylobacter jejuni</a></i> <ul><li><a href="/wiki/Campylobacteriosis" title="Campylobacteriosis">Campylobacteriosis</a>, <a href="/wiki/Guillain%E2%80%93Barr%C3%A9_syndrome" title="Guillain–Barré syndrome">Guillain–Barré syndrome</a></li></ul></li> <li><i><a href="/wiki/Helicobacter_pylori" title="Helicobacter pylori">Helicobacter pylori</a></i> <ul><li><a href="/wiki/Peptic_ulcer" class="mw-redirect" title="Peptic ulcer">Peptic ulcer</a>, <a href="/wiki/MALT_lymphoma" title="MALT lymphoma">MALT lymphoma</a>, <a href="/wiki/Gastric_cancer" class="mw-redirect" title="Gastric cancer">Gastric cancer</a></li></ul></li> <li><i><a href="/wiki/Helicobacter_cinaedi" title="Helicobacter cinaedi">Helicobacter cinaedi</a></i> <ul><li><a href="/wiki/Helicobacter_cellulitis" title="Helicobacter cellulitis"><i>Helicobacter</i> cellulitis</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374" /><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235" /></div><div role="navigation" class="navbox" aria-labelledby="Diseases_of_the_human_digestive_system290" style="padding:3px"><table class="nowraplinks mw-collapsible mw-collapsed navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374" /><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231" /><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Digestive_system_diseases" title="Template:Digestive system diseases"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Digestive_system_diseases" title="Template talk:Digestive system diseases"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Digestive_system_diseases" title="Special:EditPage/Template:Digestive system diseases"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Diseases_of_the_human_digestive_system290" style="font-size:114%;margin:0 4em">Diseases of the <a href="/wiki/Human_digestive_system" title="Human digestive system">human digestive system</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Gastrointestinal_tract#Upper_gastrointestinal_tract" title="Gastrointestinal tract">Upper GI tract</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Esophageal_disease" title="Esophageal disease">Esophagus</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Esophagitis" title="Esophagitis">Esophagitis</a> <ul><li><a href="/wiki/Esophageal_candidiasis" title="Esophageal candidiasis">Candidal</a></li> <li><a href="/wiki/Eosinophilic_esophagitis" title="Eosinophilic esophagitis">Eosinophilic</a></li> <li><a href="/wiki/Herpetiform_esophagitis" class="mw-redirect" title="Herpetiform esophagitis">Herpetiform</a></li></ul></li> <li><i>Rupture</i> <ul><li><a href="/wiki/Boerhaave_syndrome" class="mw-redirect" title="Boerhaave syndrome">Boerhaave syndrome</a></li> <li><a href="/wiki/Mallory%E2%80%93Weiss_syndrome" title="Mallory–Weiss syndrome">Mallory–Weiss syndrome</a></li></ul></li> <li><a href="/wiki/Zenker%27s_diverticulum" title="Zenker's diverticulum">Zenker's diverticulum</a></li> <li><a href="/wiki/Barrett%27s_esophagus" title="Barrett's esophagus">Barrett's esophagus</a></li> <li><a href="/wiki/Esophageal_motility_disorder" title="Esophageal motility disorder">Esophageal motility disorder</a> <ul><li><a href="/wiki/Nutcracker_esophagus" title="Nutcracker esophagus">Nutcracker esophagus</a></li> <li><a href="/wiki/Achalasia" class="mw-redirect" title="Achalasia">Achalasia</a></li> <li><a href="/wiki/Esophagogastric_junction_outflow_obstruction" title="Esophagogastric junction outflow obstruction">Esophagogastric junction outflow obstruction</a></li> <li><a href="/wiki/Diffuse_esophageal_spasm" title="Diffuse esophageal spasm">Diffuse esophageal spasm</a></li> <li><a href="/wiki/Gastroesophageal_reflux_disease" title="Gastroesophageal reflux disease">Gastroesophageal reflux disease</a> (GERD)</li></ul></li> <li><a href="/wiki/Laryngopharyngeal_reflux" title="Laryngopharyngeal reflux">Laryngopharyngeal reflux</a> (LPR)</li> <li><a href="/wiki/Esophageal_stricture" title="Esophageal stricture">Esophageal stricture</a></li> <li><a href="/wiki/Esophageal_inlet_patch" title="Esophageal inlet patch">Inlet patch</a></li> <li><a href="/wiki/Megaesophagus" title="Megaesophagus">Megaesophagus</a></li> <li><a href="/wiki/Esophageal_intramural_pseudodiverticulosis" title="Esophageal intramural pseudodiverticulosis">Esophageal intramural pseudodiverticulosis</a></li> <li><a href="/wiki/Acute_esophageal_necrosis" title="Acute esophageal necrosis">Acute esophageal necrosis</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Stomach_disease" title="Stomach disease">Stomach</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Gastritis" title="Gastritis">Gastritis</a> <ul><li><a href="/wiki/Atrophic_gastritis" title="Atrophic gastritis">Atrophic</a></li> <li><a href="/wiki/M%C3%A9n%C3%A9trier%27s_disease" title="Ménétrier's disease">Ménétrier's disease</a></li> <li><a href="/wiki/Gastroenteritis" title="Gastroenteritis">Gastroenteritis</a></li></ul></li> <li><a href="/wiki/Peptic_ulcer" class="mw-redirect" title="Peptic ulcer">Peptic (gastric) ulcer</a> <ul><li><a href="/wiki/Cushing_ulcer" title="Cushing ulcer">Cushing ulcer</a></li> <li><a href="/wiki/Dieulafoy%27s_lesion" title="Dieulafoy's lesion">Dieulafoy's lesion</a></li></ul></li> <li><a href="/wiki/Dyspepsia" class="mw-redirect" title="Dyspepsia">Dyspepsia</a> <ul><li><a href="/wiki/Functional_dyspepsia" title="Functional dyspepsia">Functional dyspepsia</a></li></ul></li> <li><a href="/wiki/Pyloric_stenosis" title="Pyloric stenosis">Pyloric stenosis</a></li> <li><a href="/wiki/Achlorhydria" title="Achlorhydria">Achlorhydria</a></li> <li><a href="/wiki/Gastroparesis" title="Gastroparesis">Gastroparesis</a></li> <li><a href="/wiki/Gastroptosis" title="Gastroptosis">Gastroptosis</a></li> <li><a href="/wiki/Portal_hypertensive_gastropathy" title="Portal hypertensive gastropathy">Portal hypertensive gastropathy</a></li> <li><a href="/wiki/Gastric_antral_vascular_ectasia" title="Gastric antral vascular ectasia">Gastric antral vascular ectasia</a></li> <li><a href="/wiki/Gastric_dumping_syndrome" class="mw-redirect" title="Gastric dumping syndrome">Gastric dumping syndrome</a></li> <li><a href="/wiki/Gastric_volvulus" title="Gastric volvulus">Gastric volvulus</a></li> <li><a href="/wiki/Buried_bumper_syndrome" title="Buried bumper syndrome">Buried bumper syndrome</a></li> <li><a href="/wiki/Gastrinoma" title="Gastrinoma">Gastrinoma</a> <ul><li><a href="/wiki/Zollinger%E2%80%93Ellison_syndrome" title="Zollinger–Ellison syndrome">Zollinger–Ellison syndrome</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Gastrointestinal_tract#Lower_gastrointestinal_tract" title="Gastrointestinal tract">Lower GI tract</a> <br /> <a href="/wiki/Enteropathy" title="Enteropathy">Enteropathy</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Small_intestine" title="Small intestine">Small intestine</a> <br /> (<a href="/wiki/Duodenum" title="Duodenum">Duodenum</a>/<a href="/wiki/Jejunum" title="Jejunum">Jejunum</a>/<a href="/wiki/Ileum" title="Ileum">Ileum</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Enteritis" title="Enteritis">Enteritis</a> <ul><li><a href="/wiki/Duodenitis" title="Duodenitis">Duodenitis</a></li> <li><a href="/wiki/Jejunitis" title="Jejunitis">Jejunitis</a></li> <li><a href="/wiki/Ileitis" title="Ileitis">Ileitis</a></li></ul></li> <li><a href="/wiki/Peptic_ulcer" class="mw-redirect" title="Peptic ulcer">Peptic (duodenal) ulcer</a> <ul><li><a href="/wiki/Curling%27s_ulcer" title="Curling's ulcer">Curling's ulcer</a></li></ul></li> <li><a href="/wiki/Malabsorption" title="Malabsorption">Malabsorption</a>: <a href="/wiki/Coeliac_disease" title="Coeliac disease">Coeliac</a></li> <li><a href="/wiki/Tropical_sprue" title="Tropical sprue">Tropical sprue</a></li> <li><a href="/wiki/Blind_loop_syndrome" title="Blind loop syndrome">Blind loop syndrome</a></li> <li><a href="/wiki/Small_intestinal_bacterial_overgrowth" title="Small intestinal bacterial overgrowth">Small intestinal bacterial overgrowth</a></li> <li><a href="/wiki/Whipple%27s_disease" title="Whipple's disease">Whipple's</a></li> <li><a href="/wiki/Short_bowel_syndrome" title="Short bowel syndrome">Short bowel syndrome</a></li> <li><a href="/wiki/Steatorrhea" title="Steatorrhea">Steatorrhea</a></li> <li><a href="/wiki/Milroy_disease" class="mw-redirect" title="Milroy disease">Milroy disease</a></li> <li><a href="/wiki/Bile_acid_malabsorption" title="Bile acid malabsorption">Bile acid malabsorption</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Large_intestine" title="Large intestine">Large intestine</a> <br /> (<a href="/wiki/Vermiform_appendix" class="mw-redirect" title="Vermiform appendix">Appendix</a>/<a href="/wiki/Colon_(anatomy)" class="mw-redirect" title="Colon (anatomy)">Colon</a>)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Appendicitis" title="Appendicitis">Appendicitis</a></li> <li><a href="/wiki/Colitis" title="Colitis">Colitis</a> <ul><li><a href="/wiki/Pseudomembranous_colitis" class="mw-redirect" title="Pseudomembranous colitis">Pseudomembranous</a></li> <li><a href="/wiki/Ulcerative_colitis" title="Ulcerative colitis">Ulcerative</a></li> <li><a href="/wiki/Ischemic_colitis" title="Ischemic colitis">Ischemic</a></li> <li><a href="/wiki/Microscopic_colitis" title="Microscopic colitis">Microscopic</a></li> <li><a href="/wiki/Collagenous_colitis" title="Collagenous colitis">Collagenous</a></li> <li><a href="/wiki/Lymphocytic_colitis" title="Lymphocytic colitis">Lymphocytic</a></li></ul></li> <li><a href="/wiki/Dysentery" title="Dysentery">Dysentery</a></li> <li><a href="/wiki/Functional_colonic_disease" class="mw-redirect" title="Functional colonic disease">Functional colonic disease</a> <ul><li><a href="/wiki/Irritable_bowel_syndrome" title="Irritable bowel syndrome">IBS</a></li> <li><a href="/wiki/Intestinal_pseudoobstruction" class="mw-redirect" title="Intestinal pseudoobstruction">Intestinal pseudoobstruction</a> / <a href="/wiki/Ogilvie_syndrome" title="Ogilvie syndrome">Ogilvie syndrome</a></li></ul></li> <li><a href="/wiki/Megacolon" title="Megacolon">Megacolon</a> / <a href="/wiki/Toxic_megacolon" title="Toxic megacolon">Toxic megacolon</a></li> <li><a href="/wiki/Diverticulitis" title="Diverticulitis">Diverticulitis</a>/<a href="/wiki/Diverticulosis" title="Diverticulosis">Diverticulosis</a>/<a href="/wiki/Segmental_colitis_associated_with_diverticulosis" title="Segmental colitis associated with diverticulosis">SCAD</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Large and/or small</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Enterocolitis" title="Enterocolitis">Enterocolitis</a> <ul><li><a href="/wiki/Necrotizing_enterocolitis" title="Necrotizing enterocolitis">Necrotizing</a></li></ul></li> <li><a href="/wiki/Gastroenterocolitis" title="Gastroenterocolitis">Gastroenterocolitis</a></li> <li><a href="/wiki/Inflammatory_bowel_disease" title="Inflammatory bowel disease">IBD</a> <ul><li><a href="/wiki/Crohn%27s_disease" title="Crohn's disease">Crohn's disease</a></li></ul></li> <li><i><a href="/wiki/Vascular_disease" title="Vascular disease">Vascular</a></i>: <a href="/wiki/Abdominal_angina" title="Abdominal angina">Abdominal angina</a></li> <li><a href="/wiki/Mesenteric_ischemia" class="mw-redirect" title="Mesenteric ischemia">Mesenteric ischemia</a></li> <li><a href="/wiki/Angiodysplasia" title="Angiodysplasia">Angiodysplasia</a></li> <li><a href="/wiki/Bowel_obstruction" title="Bowel obstruction">Bowel obstruction</a>: <a href="/wiki/Ileus" title="Ileus">Ileus</a></li> <li><a href="/wiki/Intussusception_(medical_disorder)" title="Intussusception (medical disorder)">Intussusception</a></li> <li><a href="/wiki/Volvulus" title="Volvulus">Volvulus</a></li> <li><a href="/wiki/Fecal_impaction" title="Fecal impaction">Fecal impaction</a></li> <li><a href="/wiki/Constipation" title="Constipation">Constipation</a> <ul><li><a href="/wiki/Functional_constipation" title="Functional constipation">Functional</a></li></ul></li> <li><a href="/wiki/Diarrhea" title="Diarrhea">Diarrhea</a> <ul><li><a href="/wiki/Infectious_diarrhea" class="mw-redirect" title="Infectious diarrhea">Infectious</a></li></ul></li> <li><a href="/wiki/Adhesion_(medicine)" title="Adhesion (medicine)">Intestinal adhesions</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Rectum" title="Rectum">Rectum</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Proctitis" title="Proctitis">Proctitis</a> <ul><li><a href="/wiki/Radiation_proctitis" title="Radiation proctitis">Radiation proctitis</a></li></ul></li> <li><a href="/wiki/Proctalgia_fugax" title="Proctalgia fugax">Proctalgia fugax</a></li> <li><a href="/wiki/Rectal_prolapse" title="Rectal prolapse">Rectal prolapse</a> (<a href="/wiki/Internal_rectal_prolapse" title="Internal rectal prolapse">Internal rectal prolapse</a>)</li> <li><a href="/wiki/Anismus" title="Anismus">Anismus</a></li> <li><a href="/wiki/Solitary_rectal_ulcer_syndrome" title="Solitary rectal ulcer syndrome">Solitary rectal ulcer syndrome</a></li> <li><a href="/wiki/Rectal_stricture" title="Rectal stricture">Rectal stricture</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Anal_canal" title="Anal canal">Anal canal</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Anal_fissure" title="Anal fissure">Anal fissure</a>/<a href="/wiki/Anal_fistula" title="Anal fistula">Anal fistula</a></li> <li><a href="/wiki/Anal_abscess" class="mw-redirect" title="Anal abscess">Anal abscess</a></li> <li><a href="/wiki/Hemorrhoid" title="Hemorrhoid">Hemorrhoid</a></li> <li><a href="/wiki/Anal_dysplasia" title="Anal dysplasia">Anal dysplasia</a></li> <li><a href="/wiki/Pruritus_ani" title="Pruritus ani">Pruritus ani</a></li> <li><a href="/wiki/Anal_stricture" title="Anal stricture">Anal stricture</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Gastrointestinal_bleeding" title="Gastrointestinal bleeding">GI bleeding</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Blood_in_stool" title="Blood in stool">Blood in stool</a></li> <li><a href="/wiki/Upper_gastrointestinal_bleeding" title="Upper gastrointestinal bleeding">Upper</a> <ul><li><a href="/wiki/Hematemesis" title="Hematemesis">Hematemesis</a></li> <li><a href="/wiki/Melena" title="Melena">Melena</a></li></ul></li> <li><a href="/wiki/Lower_gastrointestinal_bleeding" title="Lower gastrointestinal bleeding">Lower</a> <ul><li><a href="/wiki/Hematochezia" title="Hematochezia">Hematochezia</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Accessory_digestive_gland" class="mw-redirect" title="Accessory digestive gland">Accessory</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Liver_disease" title="Liver disease">Liver</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Hepatitis" title="Hepatitis">Hepatitis</a> <ul><li><a href="/wiki/Viral_hepatitis" title="Viral hepatitis">Viral hepatitis</a></li> <li><a href="/wiki/Autoimmune_hepatitis" title="Autoimmune hepatitis">Autoimmune hepatitis</a></li> <li><a href="/wiki/Alcoholic_hepatitis" title="Alcoholic hepatitis">Alcoholic hepatitis</a></li></ul></li> <li><a href="/wiki/Cirrhosis" title="Cirrhosis">Cirrhosis</a> <ul><li><a href="/wiki/Primary_biliary_cirrhosis" class="mw-redirect" title="Primary biliary cirrhosis">PBC</a></li></ul></li> <li><a href="/wiki/Fatty_liver" class="mw-redirect" title="Fatty liver">Fatty liver</a> <ul><li><a href="/wiki/Metabolic_dysfunction%E2%80%93associated_steatotic_liver_disease" title="Metabolic dysfunction–associated steatotic liver disease">MASLD</a></li></ul></li> <li><i><a href="/wiki/Vascular_disease" title="Vascular disease">Vascular</a></i> <ul><li><a href="/wiki/Budd%E2%80%93Chiari_syndrome" title="Budd–Chiari syndrome">Budd–Chiari syndrome</a></li> <li><a href="/wiki/Hepatic_veno-occlusive_disease" title="Hepatic veno-occlusive disease">Hepatic veno-occlusive disease</a></li> <li><a href="/wiki/Portal_hypertension" title="Portal hypertension">Portal hypertension</a></li> <li><a href="/wiki/Nutmeg_liver" class="mw-redirect" title="Nutmeg liver">Nutmeg liver</a></li></ul></li> <li><a href="/wiki/Alcoholic_liver_disease" title="Alcoholic liver disease">Alcoholic liver disease</a></li> <li><a href="/wiki/Liver_failure" title="Liver failure">Liver failure</a> <ul><li><a href="/wiki/Hepatic_encephalopathy" title="Hepatic encephalopathy">Hepatic encephalopathy</a></li> <li><a href="/wiki/Acute_liver_failure" title="Acute liver failure">Acute liver failure</a></li></ul></li> <li><a href="/wiki/Liver_abscess" title="Liver abscess">Liver abscess</a> <ul><li><a href="/wiki/Pyogenic_liver_abscess" title="Pyogenic liver abscess">Pyogenic</a></li> <li><a href="/wiki/Amoebic_liver_abscess" title="Amoebic liver abscess">Amoebic</a></li></ul></li> <li><a href="/wiki/Hepatorenal_syndrome" title="Hepatorenal syndrome">Hepatorenal syndrome</a></li> <li><a href="/wiki/Peliosis_hepatis" title="Peliosis hepatis">Peliosis hepatis</a></li> <li><a href="/wiki/Metabolic_disorder" title="Metabolic disorder">Metabolic disorders</a> <ul><li><a href="/wiki/Wilson%27s_disease" title="Wilson's disease">Wilson's disease</a></li> <li><a href="/wiki/Hemochromatosis" class="mw-redirect" title="Hemochromatosis">Hemochromatosis</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Gallbladder_disease" title="Gallbladder disease">Gallbladder</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Cholecystitis" title="Cholecystitis">Cholecystitis</a></li> <li><a href="/wiki/Gallstone" title="Gallstone">Gallstone / Cholelithiasis</a></li> <li><a href="/wiki/Cholesterolosis_of_gallbladder" title="Cholesterolosis of gallbladder">Cholesterolosis</a></li> <li><a href="/wiki/Adenomyomatosis" title="Adenomyomatosis">Adenomyomatosis</a></li> <li><a href="/wiki/Postcholecystectomy_syndrome" title="Postcholecystectomy syndrome">Postcholecystectomy syndrome</a></li> <li><a href="/wiki/Porcelain_gallbladder" title="Porcelain gallbladder">Porcelain gallbladder</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Bile_duct" title="Bile duct">Bile duct</a>/ <br /> Other <a href="/wiki/Biliary_tree" class="mw-redirect" title="Biliary tree">biliary tree</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Cholangitis" class="mw-redirect" title="Cholangitis">Cholangitis</a> <ul><li><a href="/wiki/Primary_sclerosing_cholangitis" title="Primary sclerosing cholangitis">Primary sclerosing cholangitis</a></li> <li><a href="/wiki/Secondary_sclerosing_cholangitis" title="Secondary sclerosing cholangitis">Secondary sclerosing cholangitis</a></li> <li><a href="/wiki/Ascending_cholangitis" title="Ascending cholangitis">Ascending</a></li></ul></li> <li><a href="/wiki/Cholestasis" title="Cholestasis">Cholestasis</a>/<a href="/wiki/Mirizzi%27s_syndrome" title="Mirizzi's syndrome">Mirizzi's syndrome</a></li> <li><a href="/wiki/Biliary_fistula" title="Biliary fistula">Biliary fistula</a></li> <li><a href="/wiki/Haemobilia" title="Haemobilia">Haemobilia</a></li></ul> <ul><li><i><a href="/wiki/Common_bile_duct" title="Common bile duct">Common bile duct</a></i> <ul><li><a href="/wiki/Choledocholithiasis" class="mw-redirect" title="Choledocholithiasis">Choledocholithiasis</a></li> <li><a href="/wiki/Biliary_dyskinesia" title="Biliary dyskinesia">Biliary dyskinesia</a></li></ul></li> <li><a href="/wiki/Sphincter_of_Oddi_dysfunction" title="Sphincter of Oddi dysfunction">Sphincter of Oddi dysfunction</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Pancreatic_disease" title="Pancreatic disease">Pancreatic</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Pancreatitis" title="Pancreatitis">Pancreatitis</a> <ul><li><a href="/wiki/Acute_pancreatitis" title="Acute pancreatitis">Acute</a></li> <li><a href="/wiki/Chronic_pancreatitis" title="Chronic pancreatitis">Chronic</a></li> <li><a href="/wiki/Hereditary_pancreatitis" title="Hereditary pancreatitis">Hereditary</a></li> <li><a href="/wiki/Pancreatic_abscess" title="Pancreatic abscess">Pancreatic abscess</a></li></ul></li> <li><a href="/wiki/Pancreatic_pseudocyst" title="Pancreatic pseudocyst">Pancreatic pseudocyst</a></li> <li><a href="/wiki/Exocrine_pancreatic_insufficiency" title="Exocrine pancreatic insufficiency">Exocrine pancreatic insufficiency</a></li> <li><a href="/wiki/Pancreatic_fistula" title="Pancreatic fistula">Pancreatic fistula</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="Hernia43" scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Hernia" title="Hernia">Hernia</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Diaphragmatic_hernia" title="Diaphragmatic hernia">Diaphragmatic</a> <ul><li><a href="/wiki/Congenital_diaphragmatic_hernia" title="Congenital diaphragmatic hernia">Congenital</a></li></ul></li> <li><a href="/wiki/Hiatus_hernia" class="mw-redirect" title="Hiatus hernia">Hiatus</a></li></ul> <ul><li><a href="/wiki/Inguinal_hernia" title="Inguinal hernia">Inguinal</a> <ul><li><a href="/wiki/Indirect_inguinal_hernia" class="mw-redirect" title="Indirect inguinal hernia">Indirect</a></li> <li><a href="/wiki/Direct_inguinal_hernia" class="mw-redirect" title="Direct inguinal hernia">Direct</a></li></ul></li> <li><a href="/wiki/Umbilical_hernia" title="Umbilical hernia">Umbilical</a></li> <li><a href="/wiki/Femoral_hernia" title="Femoral hernia">Femoral</a></li> <li><a href="/wiki/Obturator_hernia" title="Obturator hernia">Obturator</a></li> <li><a href="/wiki/Spigelian_hernia" title="Spigelian hernia">Spigelian</a></li></ul> <ul><li><i><a href="/wiki/Lumbar_hernia" class="mw-redirect" title="Lumbar hernia">Lumbar</a></i> <ul><li><a href="/wiki/Petit%27s_hernia" title="Petit's hernia">Petit's</a></li> <li><a href="/wiki/Grynfeltt%E2%80%93Lesshaft_hernia" title="Grynfeltt–Lesshaft hernia">Grynfeltt–Lesshaft</a></li></ul></li></ul> <ul><li><i>Undefined location</i> <ul><li><a href="/wiki/Incisional_hernia" title="Incisional hernia">Incisional</a></li> <li><a href="/wiki/Internal_hernia" title="Internal hernia">Internal hernia</a></li> <li><a href="/wiki/Richter%27s_hernia" title="Richter's hernia">Richter's</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Peritoneal_disease" class="mw-redirect" title="Peritoneal disease">Peritoneal</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Peritonitis" title="Peritonitis">Peritonitis</a> <ul><li><a href="/wiki/Spontaneous_bacterial_peritonitis" title="Spontaneous bacterial peritonitis">Spontaneous bacterial peritonitis</a></li></ul></li> <li><a href="/wiki/Hemoperitoneum" title="Hemoperitoneum">Hemoperitoneum</a></li> <li><a href="/wiki/Pneumoperitoneum" title="Pneumoperitoneum">Pneumoperitoneum</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374" /><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235" /><style data-mw-deduplicate="TemplateStyles:r1038841319">.mw-parser-output .tooltip-dotted{border-bottom:1px dotted;cursor:help}</style></div><div role="navigation" class="navbox authority-control" 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