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K25.4 – Chronic Gastric Ulcer Without Hemorrhage
K25.4 is an ICD-10 diagnosis code for a chronic gastric ulcer (ulcus ventriculi) without hemorrhage and without perforation.
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K25.4 is an ICD-10 diagnosis code for a chronic gastric ulcer (ulcus ventriculi) without hemorrhage and without perforation.
What Does the ICD-10 Code K25.4 Mean?
The ICD-10 code K25.4 refers to a chronic gastric ulcer without hemorrhage and without perforation. A gastric ulcer is a sore (ulceration) that forms in the lining of the stomach and can extend into deeper layers of the stomach wall. The code belongs to the ICD-10 group K25 (gastric ulcer) and specifies a chronic course without acute complications such as bleeding or perforation of the stomach wall.
Causes
A chronic gastric ulcer develops when the balance between acid-producing factors and the protective mechanisms of the stomach lining is disrupted. The most common causes include:
- Helicobacter pylori infection: This bacterium colonizes the stomach lining and promotes ulcer formation.
- Use of nonsteroidal anti-inflammatory drugs (NSAIDs): Painkillers such as ibuprofen or diclofenac can damage the protective mucous layer of the stomach.
- Excess stomach acid production: An overproduction of gastric acid attacks the stomach lining.
- Smoking and alcohol consumption: Both weaken the mucosal barrier and slow down healing.
- Chronic stress: Stress can increase acid production and impair mucosal regeneration.
Symptoms
Typical symptoms of a chronic gastric ulcer (K25.4) include:
- Burning or dull pain in the upper abdomen, often shortly after eating
- Nausea and sometimes vomiting
- Feeling of fullness and loss of appetite
- Heartburn and acid reflux
- Weight loss in prolonged cases
Unlike duodenal ulcers, the pain associated with gastric ulcers often occurs shortly after eating and does not improve with food intake.
Diagnosis
Diagnosis of a gastric ulcer is typically established through the following investigations:
- Gastroscopy (esophagogastroduodenoscopy, EGD): The most important examination, allowing direct visualization of the ulcer and collection of a tissue sample (biopsy).
- Helicobacter pylori testing: Breath tests, stool antigen tests, or biopsy-based tests are used to detect an active infection.
- Laboratory tests: Blood count and other values may reveal associated conditions such as anemia.
Treatment
Treatment depends on the underlying cause of the ulcer:
- Helicobacter pylori eradication: If an infection is confirmed, a combination therapy of antibiotics and a proton pump inhibitor (PPI) is used to eliminate the bacteria.
- Proton pump inhibitors (PPIs): Medications such as omeprazole or pantoprazole reduce stomach acid production and support mucosal healing.
- Discontinuation of NSAIDs: Where possible, the causative painkillers should be stopped or replaced with stomach-friendlier alternatives.
- Lifestyle modifications: Quitting smoking, reducing alcohol intake, managing stress, and adjusting dietary habits all support healing.
Since K25.4 describes the chronic form without acute bleeding or perforation, conservative (non-surgical) treatment is usually sufficient. Regular follow-up endoscopies are important to monitor healing and to rule out malignant changes.
References
- World Health Organization (WHO): ICD-10 Version 2019, Code K25 - Gastric ulcer. Available at: https://icd.who.int/browse10/
- Malfertheiner P et al.: Management of Helicobacter pylori infection -- the Maastricht V/Florence Consensus Report. Gut. 2017;66(1):6-30.
- Lanas A, Chan FKL: Peptic ulcer disease. Lancet. 2017;390(10094):613-624.
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