side by side comparison

GERD vs Peptic Ulcer Disease: Acid in the Wrong Place — Esophagus vs Stomach/Duodenum

All three conditions involve acid destroying tissue, but the pain patterns are mirror images of each other. Pick the wrong pain-meal relationship on the NCLEX and you'll select the wrong teaching, wrong medication timing, and wrong complication to monitor.

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Comparison

Side-by-side3 compared
Comparevs
Dimension
GERD
Gastric Ulcer
Duodenal Ulcer
Pathophysiology & risk
  • Reflux past incompetent LES
  • Lower esophageal mucosa injured
  • Mucosal erosion, stomach body/antrum
  • H. pylori present in ~70%
  • Erosion in duodenal bulb past pylorus
  • H. pylori present in ~90%
Signs & symptoms
  • ★Substernal burning (heartburn)
  • Regurgitation
  • worse lying flat
  • Epigastric gnawing pain, midline
  • ★Pain WITH eating, 30 min–1 hr after
  • ★Pain BETWEEN meals, 2–4 hr after
  • night pain
  • Epigastric gnawing
  • food/antacids relieve
Diagnostics & labs
  • 24-hr esophageal pH monitoring
  • EGD for complications
  • EGD + biopsy to rule out malignancy
  • H. pylori test
  • H. pylori test
  • Urea breath or stool antigen test
Nursing priorities
  • Elevate HOB 30°
  • upright after meals
  • No food 2–3 hr before bed
  • Monitor for GI bleed
  • Stop NSAIDs/aspirin
  • Monitor for GI bleed
  • Stop NSAIDs/aspirin
Management
  • PPI or H2 blocker
  • PRN antacids
  • No antibiotics needed
  • PPI + triple therapy if H. pylori+
  • PPI + clarithromycin + amoxicillin ×14d
  • PPI + triple therapy if H. pylori+
  • Same regimen as gastric ulcer
Patient teaching
  • Avoid alcohol, caffeine, large/fatty meals
  • Weight loss
  • avoid tight clothing
  • Limit alcohol
  • smoking cessation
  • Avoid spicy/acidic foods that worsen pain
  • Smoking cessation
  • manage stress
  • Regular meal schedule
Red flags — escalate
  • Dysphagia or weight loss then endoscopy
  • Hematemesis then GI hemorrhage
  • Rigid abdomen then perforation
  • Melena then GI hemorrhage
  • Rigid abdomen then perforation
Complications
  • ★Barrett esophagus
  • Esophageal adenocarcinoma risk
  • Hemorrhage, perforation
  • Higher malignancy risk — always biopsy
  • Hemorrhage, perforation
  • Gastric outlet obstruction from scarring
Pathophysiology & risk

GERD

  • Reflux past incompetent LES
  • Lower esophageal mucosa injured

Gastric Ulcer

  • Mucosal erosion, stomach body/antrum
  • H. pylori present in ~70%
Signs & symptoms

GERD

  • ★Substernal burning (heartburn)
  • Regurgitation
  • worse lying flat

Gastric Ulcer

  • Epigastric gnawing pain, midline
  • ★Pain WITH eating, 30 min–1 hr after
Diagnostics & labs

GERD

  • 24-hr esophageal pH monitoring
  • EGD for complications

Gastric Ulcer

  • EGD + biopsy to rule out malignancy
  • H. pylori test
Nursing priorities

GERD

  • Elevate HOB 30°
  • upright after meals
  • No food 2–3 hr before bed

Gastric Ulcer

  • Monitor for GI bleed
  • Stop NSAIDs/aspirin
Management

GERD

  • PPI or H2 blocker
  • PRN antacids
  • No antibiotics needed

Gastric Ulcer

  • PPI + triple therapy if H. pylori+
  • PPI + clarithromycin + amoxicillin ×14d
Patient teaching

GERD

  • Avoid alcohol, caffeine, large/fatty meals
  • Weight loss
  • avoid tight clothing

Gastric Ulcer

  • Limit alcohol
  • smoking cessation
  • Avoid spicy/acidic foods that worsen pain
Red flags — escalate

GERD

  • Dysphagia or weight loss then endoscopy

Gastric Ulcer

  • Hematemesis then GI hemorrhage
  • Rigid abdomen then perforation
Complications

GERD

  • ★Barrett esophagus
  • Esophageal adenocarcinoma risk

Gastric Ulcer

  • Hemorrhage, perforation
  • Higher malignancy risk — always biopsy

★ marks the fact that sets a column apart.

Clinical Pearl

Gastric ulcer — food hurts. Duodenal ulcer — food helps. GERD — lying flat hurts.

Component Topics

GERDPeptic Ulcer Disease

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