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K28.4 – Chronic Gastrojejunal Ulcer | ICD-10
K28.4 is an ICD-10 diagnosis code for a chronic gastrojejunal ulcer without hemorrhage and without perforation.
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K28.4 is an ICD-10 diagnosis code for a chronic gastrojejunal ulcer without hemorrhage and without perforation.
What does the diagnosis code K28.4 mean?
The ICD-10 code K28.4 refers to a chronic gastrojejunal ulcer without hemorrhage and without perforation. A gastrojejunal ulcer (also called an anastomotic ulcer or peptic ulcer of the jejunum) is an ulcer that forms at the connection point (anastomosis) between the stomach and the jejunum (the middle section of the small intestine). This condition typically occurs after surgical procedures in which the stomach and small intestine have been directly joined together.
Classification in ICD-10
The code belongs to the group K28 – Gastrojejunal ulcer within Chapter XI (Diseases of the Digestive System). The fourth digit “.4” specifies: chronic course, with neither acute hemorrhage nor perforation (a breakthrough through the intestinal wall) present.
Causes
Gastrojejunal ulcers often develop as a result of certain stomach surgeries, such as:
- Billroth I or Billroth II gastrectomy (partial stomach removal with reconstruction)
- Gastrojejunostomy (surgical connection of the stomach to the jejunum, e.g., gastric bypass surgery)
Additional contributing factors include:
- Infection with Helicobacter pylori (a stomach bacterium)
- Regular use of NSAIDs (non-steroidal anti-inflammatory drugs, e.g., ibuprofen, diclofenac)
- Increased acid production in the remnant stomach
- Smoking and excessive alcohol consumption
Symptoms
Chronic gastrojejunal ulcers (K28.4) often progress without acute complications but may cause the following symptoms:
- Persistent or recurring upper abdominal pain, often after eating
- Nausea and a feeling of fullness
- Mild digestive disturbances
- Unspecific pressure sensation in the abdominal area
- Possible weight loss with prolonged illness
Diagnosis
Diagnosis of a gastrojejunal ulcer is typically established through:
- Endoscopy (gastroscopy with direct visualization of the anastomosis)
- Biopsy (tissue sample to test for Helicobacter pylori or malignant changes)
- Imaging studies (e.g., contrast X-ray of the gastrointestinal tract)
- Laboratory tests (e.g., blood count, stool test for Helicobacter pylori)
Treatment
Treatment of the chronic gastrojejunal ulcer is guided by the underlying cause and severity:
- Proton pump inhibitors (PPIs) such as omeprazole or pantoprazole to suppress gastric acid production
- Antibiotic eradication therapy for confirmed Helicobacter pylori infection (triple or quadruple therapy)
- Discontinuing or reducing NSAIDs, or switching to more stomach-friendly alternatives
- Lifestyle changes: smoking cessation, alcohol avoidance, adjusted diet
- In therapy-resistant cases: repeat surgical intervention
References
- World Health Organization (WHO): ICD-10 International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Volume 1.
- Laine L, Takeuchi K, Tarnawski A. Gastric mucosal defense and cytoprotection: bench to bedside. Gastroenterology. 2008;135(1):41–60.
- Malfertheiner P, Megraud F, O'Morain CA et al. Management of Helicobacter pylori infection – the Maastricht V/Florence Consensus Report. Gut. 2017;66(1):6–30.
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