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K26.4 – Chronic Duodenal Ulcer ICD-10
K26.4 is an ICD-10 diagnosis code for a chronic duodenal ulcer without haemorrhage or perforation. It describes a recurring wound in the lining of the duodenum.
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K26.4 is an ICD-10 diagnosis code for a chronic duodenal ulcer without haemorrhage or perforation. It describes a recurring wound in the lining of the duodenum.
What does K26.4 mean?
K26.4 is a diagnosis code from the ICD-10 (International Classification of Diseases, 10th Revision). It stands for a chronic duodenal ulcer without haemorrhage and without perforation – meaning a long-lasting wound in the lining of the duodenum that is neither actively bleeding nor has broken through the intestinal wall.
What is a duodenal ulcer?
A duodenal ulcer is an open sore or defect in the mucosal lining of the duodenum – the first part of the small intestine, located directly after the stomach. The protective lining is damaged by stomach acid or other harmful factors and can no longer repair itself adequately.
Causes
- Helicobacter pylori: Infection with this bacterium is the most common cause. It weakens the protective mucous layer of the duodenum.
- Non-steroidal anti-inflammatory drugs (NSAIDs): Pain relievers such as ibuprofen or diclofenac can irritate the mucosal lining and lead to ulcer formation.
- Increased stomach acid production: Excess acid erodes the duodenal lining.
- Smoking: Promotes the development and recurrence of ulcers.
- Chronic stress: Can increase stomach acid secretion.
- Zollinger-Ellison syndrome: A rare condition in which tumours produce excessive amounts of gastric acid.
Symptoms
Many patients with a chronic duodenal ulcer (K26.4) experience recurring symptoms that often occur in episodes:
- Dull or burning upper abdominal pain, typically 2–3 hours after meals or at night
- Pain relief after eating or taking antacids (as food buffers stomach acid)
- Nausea and occasional vomiting
- Bloating and a feeling of fullness
- Loss of appetite and unintentional weight loss (less common than with gastric ulcers)
Since the code K26.4 specifically excludes haemorrhage and perforation, these patients do not show signs such as dark or tarry stools, vomiting of blood, or sudden severe abdominal pain.
Diagnosis
The diagnosis of a duodenal ulcer is typically established using the following methods:
- Upper endoscopy (oesophagogastroduodenoscopy, OGD): Direct visualisation of the ulcer using a flexible endoscope. This is considered the gold standard.
- Helicobacter pylori testing: Breath test, blood test, stool antigen test, or biopsy taken during endoscopy.
- Barium contrast X-ray: A less common alternative to endoscopy.
Treatment
Treatment is tailored to the underlying cause:
Helicobacter pylori infection
The standard approach is eradication therapy: a combination of a proton pump inhibitor (e.g. omeprazole) and two antibiotics (e.g. clarithromycin and amoxicillin) taken for 7–14 days. The goal is complete elimination of the bacterium.
NSAID-induced ulcer
Discontinuation or substitution of the pain reliever, combined with a proton pump inhibitor to protect the mucosal lining.
General measures
- Smoking cessation
- Avoiding alcohol
- Stress reduction
- Dietary adjustments (easily digestible, gentle foods)
- Long-term proton pump inhibitor therapy for frequent relapses
Course and Prognosis
The chronic duodenal ulcer (K26.4) tends to recur, particularly if the underlying cause is not addressed. However, after successful eradication of Helicobacter pylori, the relapse rate is significantly reduced. Regular follow-up examinations are recommended to detect complications such as bleeding or perforation at an early stage.
References
- World Health Organization (WHO): International Classification of Diseases, 10th Revision (ICD-10) – K26 Duodenal Ulcer.
- Malfertheiner P et al.: Management of Helicobacter pylori infection – the Maastricht VI/Florence Consensus Report. Gut, 2022.
- Lanas A, Chan FKL: Peptic ulcer disease. The Lancet, 2017; 390(10094):613–624.
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