Gastroesophageal Reflux Disease vs Peptic Ulcer Disease
Gastroesophageal Reflux Disease and Peptic Ulcer Disease are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Gastroesophageal Reflux Disease vs Peptic Ulcer Disease at a glance
- Gastroesophageal Reflux Disease: Retrograde flow of gastric contents into the esophagus producing symptoms or mucosal injury.
- Peptic Ulcer Disease: Mucosal break >5 mm in the stomach or duodenum, most often due to H. pylori or NSAIDs.
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Side-by-side comparison
| Feature | Gastroesophageal Reflux Disease | Peptic Ulcer Disease |
|---|---|---|
| At a glance | Retrograde flow of gastric contents into the esophagus producing symptoms or mucosal injury. | Mucosal break >5 mm in the stomach or duodenum, most often due to H. pylori or NSAIDs. |
| Classic presentation | Postprandial retrosternal burning relieved by antacids; nocturnal symptoms relieved by elevating the head of the bed.; Heartburn — retrosternal burning, worse postprandially or supine; Regurgitation of sour/bitter material; Dysphagia (suggests stricture, eosinophilic esophagitis, or malignancy if progressive); Water brash… | Duodenal: pain relieved by eating. Gastric: pain provoked by eating.; Epigastric pain — burning, gnawing, or hunger-like; Duodenal ulcer: pain 2-3 h after meals, relieved by food or antacids, nocturnal awakening; Gastric ulcer: pain worsened by food, weight loss; Nausea, early satiety, bloating, belching; Hematemesis, melena, or… |
| Workup / key labs | Clinical diagnosis when classic heartburn/regurgitation respond to empiric PPI trial. Objective confirmation by erosive esophagitis (LA grade C or D) on EGD, biopsy-proven Barrett esophagus, or abnormal pH study (acid exposure time >6%).; No labs required for typical, uncomplicated GERD; CBC if anemia or GI bleeding suspected | CBC (anemia from chronic blood loss); BMP, LFTs; Type and screen / crossmatch if acute bleed; H. pylori testing: urea breath test or stool antigen (preferred non-invasive); biopsy-based rapid urease test or histology if EGD performed; Fasting gastrin level if Zollinger-Ellison suspected; Withhold PPI 2 weeks and antibiotics 4 weeks… |
| Imaging | Upper endoscopy (EGD) indicated for alarm features (dysphagia, odynophagia, weight loss, GI bleeding, anemia, vomiting, age ≥60 with new symptoms) or symptoms refractory to 8 weeks of PPI; Ambulatory esophageal pH or pH-impedance monitoring — gold standard for confirming reflux when EGD is normal; performed off PPI for diagnosis or on… | Upper endoscopy (EGD) — gold standard; visualizes ulcer, allows biopsy and therapeutic intervention; biopsy ALL gastric ulcers to exclude malignancy; Upright CXR — free air under diaphragm in perforation; CT abdomen with contrast if perforation or complication suspected |
| First-line treatment | Lifestyle modification: weight loss if BMI elevated, elevate head of bed 6-8 inches, avoid recumbency for 3 h after meals, smoking and alcohol cessation, identify and remove dietary triggers; PPI — omeprazole, pantoprazole, esomeprazole — once daily 30-60 min before breakfast for 8 weeks; step-down to lowest effective dose after symptom… | PPI — omeprazole, pantoprazole, esomeprazole — 4-8 weeks (8-12 weeks for gastric ulcer); H. pylori eradication if positive (see by_subtype); Discontinue NSAIDs and aspirin if possible; switch to acetaminophen; Lifestyle: smoking cessation, limit alcohol |
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