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K28.0 - Acute Gastrojejunal Ulcer with Hemorrhage
K28.0 is an ICD-10 diagnosis code for an acute gastrojejunal ulcer with hemorrhage. It describes an acute ulcer at the stomach-small intestine junction with active bleeding.
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K28.0 is an ICD-10 diagnosis code for an acute gastrojejunal ulcer with hemorrhage. It describes an acute ulcer at the stomach-small intestine junction with active bleeding.
What does the diagnosis K28.0 mean?
The ICD-10 code K28.0 stands for an acute gastrojejunal ulcer with hemorrhage. This is a serious condition of the gastrointestinal tract in which an ulcer (an open sore) has formed at the junction between the stomach and the jejunum (the second part of the small intestine). The ulcer is acute, meaning it develops suddenly and is accompanied by active bleeding.
A gastrojejunal ulcer often develops after surgical procedures on the stomach, particularly after gastric resection or gastroenterostomy (a surgical connection between the stomach and the small intestine). These ulcers are also referred to as peptic anastomotic ulcers or stomal ulcers.
Causes
The development of a gastrojejunal ulcer can be attributed to several factors:
- Gastric acid attack: After stomach surgery, excess gastric acid can attack the sensitive mucosal tissue of the jejunum, causing ulcers to form.
- Helicobacter pylori infection: The bacterium Helicobacter pylori is a common cause of stomach ulcers and can also contribute to the development of gastrojejunal ulcers.
- Nonsteroidal anti-inflammatory drugs (NSAIDs): Pain medications such as ibuprofen or diclofenac can damage the gastric mucosa and increase the risk of ulcers.
- Corticosteroids: Long-term use of corticosteroid medications can impair mucosal repair mechanisms.
- Smoking and alcohol: Both factors increase the risk of ulcer development and recurrence.
- Zollinger-Ellison syndrome: A rare condition involving excessive gastrin production, which leads to extreme gastric acid secretion.
Symptoms
An acute gastrojejunal ulcer with hemorrhage (K28.0) can cause the following symptoms:
- Bleeding: Visible blood in vomit (hematemesis) or in the stool (melena, i.e., tarry, black stool)
- Upper abdominal pain: Burning or stabbing pain in the upper abdomen that may change after eating
- Nausea and vomiting: Nausea and possible vomiting of blood
- Dizziness and weakness: As a result of blood loss, patients may experience dizziness, palpitations, and general weakness
- Pale skin and tachycardia: Signs of significant blood loss
In the case of severe bleeding, this constitutes a medical emergency requiring immediate treatment.
Diagnosis
The diagnosis of a gastrojejunal ulcer with hemorrhage is typically established through the following examinations:
- Endoscopy (gastroscopy): The most important diagnostic method, in which a camera is inserted into the stomach and small intestine to directly visualize the ulcer and simultaneously initiate therapeutic measures
- Blood tests: Complete blood count, coagulation values, and inflammatory markers to assess blood loss and general condition
- Helicobacter pylori test: Breath test, stool test, or biopsy-based examination of gastric tissue
- Imaging: In certain cases, a computed tomography (CT) scan of the abdomen may be necessary
Treatment
Treatment of K28.0 is urgent and involves several approaches:
Emergency measures
- Stabilization of the patient through intravenous fluids and, if necessary, blood transfusions in the case of severe blood loss
- Endoscopic hemostasis (e.g., by injection, electrocoagulation, or clipping)
Pharmacological therapy
- Proton pump inhibitors (PPIs): Medications such as omeprazole or pantoprazole reduce gastric acid production and promote ulcer healing
- Helicobacter pylori eradication: If an infection is confirmed, a combination therapy of antibiotics and PPI (so-called triple therapy) is administered
- Discontinuation of NSAIDs: Where possible, triggers such as nonsteroidal anti-inflammatory drugs should be discontinued or replaced
Surgical treatment
In rare cases, when endoscopic and pharmacological measures are insufficient, a surgical procedure may be required to stop the bleeding or remove the ulcer.
Prognosis and course
With timely and appropriate treatment, the prognosis for a gastrojejunal ulcer with hemorrhage is generally good. Without treatment, however, life-threatening complications can occur, including persistent bleeding, intestinal perforation, or shock. Regular follow-up examinations are important to prevent recurrence.
References
- World Health Organization (WHO): International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10), Chapter XI - Diseases of the digestive system (K00-K93), K28 Gastrojejunal ulcer.
- Laine L, Jensen DM. Management of patients with ulcer bleeding. American Journal of Gastroenterology. 2012;107(3):345-360. doi:10.1038/ajg.2011.480
- Malfertheiner P, Megraud F, Rokkas T, et al. Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report. Gut. 2022;71(9):1724-1762. doi:10.1136/gutjnl-2022-327745
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