Duodenal ulcer and duodenal erosion J004

RMA instruments

ICD coding

• Duodenal ulcer ICD-10 K26

Brief description

Duodenal ulcers and erosions are non-malignant upper gastrointestinal pathologies affecting the duodenum resulting in ulceration of the mucosal lining. If the size of the lesion is small and/or shallow (not extending into the muscularis mucosa) it is called an erosion. If the lesion extends and penetrates into the mucosal lining of the duodenum it is called a duodenal ulcer. This SOP covers both duodenal ulcers and erosions. 

Confirming the diagnosis:

Confirmation of diagnosis requires upper gastrointestinal endoscopy, biopsy and histopathological examination. Histopathology is important to ensure SOP exclusions have been considered.

It does not need to be symptomatic.

If further advice is required, the relevant medical specialist is a gastroenterologist or general surgeon.

Additional diagnoses covered by these SOPs

• Acute duodenal ulcer
• Duodenal erosion
• Bleeding duodenal ulcer
• Chronic duodenal ulcer
• Duodenal peptic ulcer
• Perforated duodenal ulcer
• Duodenal ulcers or erosions due to duodenal foreign bodies

Conditions not covered by these SOPs

• Acute duodenitis^#
• Acute superficial mucosal erosions of the duodenum #
• Chronic gastritis*
• Gastric ulcers * - Gastric ulcer and gastric erosion SoP
• Gastric erosions * - Gastric ulcer and gastric erosion SoP
• Gastro-oesophageal reflux disease*
• Inflammatory bowel disease* - Crohn’s disease
• Malignant neoplasm of the small intestine*
• Malignant neoplasm of the stomach*
• Sarcoidosis*                                                    
• Stomach or duodenal neoplastic ulcer*
• Duodenal perforations from external trauma such as stabbing, explosive blast injury or gunshot injury * 

* another SOP applies - the SoP has the same name unless otherwise specified

^# non-SOP condition

Clinical onset

Once the diagnosis has been confirmed, clinical onset may be able to be backdated based on characteristic symptoms such as 'burning' pain in the upper abdomen (especially after eating) and nausea and vomiting.  However, these symptoms are often non-specific and may be due to other conditions, such as gastro-oesophageal reflux disease. It is important that the clinical onset is consistent with the earliest presentation of duodenal ulcer or duodenal erosion specifically and not due to other underlying causes. 

Clinical worsening

Most ulcers readily resolve with treatment. Treatment for duodenal ulcers will vary depending on the cause but can involve proton pump inhibitors (PPIs), H2 receptor antagonists, antibiotics (if H.pylori infection is identified), and antacids. If an initially diagnosed duodenal erosion or ulcer progresses to further complications such as gastrointestinal haemorrhage or perforation of the ulcer (surgical intervention will be required), this may be indicative of a clinical worsening.