Can peptic ulcer disease cause referred pain to the interscapular area?

From the Guidelines

Yes, peptic ulcer disease can cause referred pain to the interscapular area, as the shared nerve pathways between the stomach, duodenum, and the thoracic spine area can lead to pain radiation to the back, including the interscapular region. While the most common location for peptic ulcer pain is the upper abdomen, some patients may experience referred pain to the back, including the interscapular region, as noted in the context of peptic ulcer disease complications, such as perforation and bleeding, which can have significant morbidity and mortality implications 1. It's essential to consider peptic ulcer disease as a potential cause of interscapular pain, especially if accompanied by other typical symptoms, such as:

• Burning or gnawing abdominal pain
• Nausea or vomiting
• Bloating
• Early satiety
• Weight loss Given the potential severity of peptic ulcer disease complications, prompt recognition and management are crucial, involving various subspecialties, including surgeons, gastroenterologists, and radiologists, as outlined in the guidelines for perforated and bleeding peptic ulcer 1. If peptic ulcer disease is suspected, treatment usually involves:

1. Proton pump inhibitors (e.g., omeprazole 20-40 mg daily) for 4-8 weeks
2. Antibiotics if H. pylori infection is present (typically a 14-day regimen)
3. Avoiding NSAIDs and other irritants
4. Lifestyle modifications like stress reduction and dietary changes Understanding that peptic ulcer pain can refer to the back helps in considering this diagnosis when evaluating interscapular pain, especially if accompanied by other typical symptoms, and highlights the importance of prompt medical evaluation to prevent complications and improve quality of life.

From the Research

Peptic Ulcer Disease and Referred Pain

• Peptic ulcer disease is a common condition that affects the stomach and proximal duodenum, with symptoms including epigastric discomfort, loss of appetite, and weight loss 2.
• The main causes of peptic ulcer disease are Helicobacter pylori infection and nonsteroidal anti-inflammatory drug (NSAID) use 3, 4, 2, 5.
• While the typical symptoms of peptic ulcer disease include epigastric pain, nausea, vomiting, and weight loss, there is no direct evidence in the provided studies to suggest that peptic ulcer disease can cause referred pain to the interscapular area.
• However, it is known that peptic ulcer disease can have variable symptoms, particularly in older people and in patients taking ulcerogenic medications 6.
• The diagnosis and treatment of peptic ulcer disease typically involve a test-and-treat strategy for H. pylori infection, antisecretory therapy with proton pump inhibitors, and discontinuation of NSAID use if possible 3, 4, 2, 5.

Symptoms and Diagnosis

• The symptoms of peptic ulcer disease can be broad and overlap with those of other conditions, making clinical diagnosis difficult 5.
• Endoscopy is the gold standard for diagnosis, especially in older patients and those with alarm symptoms, but a test-and-treat strategy can be used for younger patients with no alarm symptoms 2, 5.
• The treatment of peptic ulcer disease typically involves a combination of proton pump inhibitors and antibiotics to eradicate H. pylori infection, as well as discontinuation of NSAID use if possible 3, 4, 2, 5.

Treatment and Management

• Numerous treatment regimens are available for peptic ulcer disease, all of which include proton pump inhibitors plus antibiotics 5.
• A new triple therapy with vonoprazan plus antibiotics has been approved and appears to be superior to conventional therapy with proton pump inhibitors plus antibiotics 5.
• Repeat testing for H. pylori should be obtained at least 4 weeks after treatment to confirm cure 5.