Diagnosis of Peptic Ulcer

Diagnosis of peptic ulcer disease can be established based on the specific symptoms. The first sign of peptic ulcer is usually the abdominal pain. Oftentimes, doctors may not use specific tests and just go ahead and treat the ulcer, while observing if the symptoms will subside. If they do, the diagnosis was correct.

Specific tests, such as esophagogastroduodenoscopy (EGD) and urea breath test, are usually performed if the treatment was unsuccessful. Direct visualization by using EGD allows identifying the severity and the location of the ulcer, and if the ulcer was not found at all, it can provide information for an alternative diagnosis.

The most common methods for making a diagnosis

Esophagogastroduodenoscopy (EGD) is a form of endoscopy that is used on patients who are suspected to have a peptic ulcer. This is considered to be a minimally invasive procedure as it is carried out without any incisions and the recovery after this procedure is minimal. An endoscope is used for this procedure, which is inserted into the patient’s mouth and gradually advanced down the esophagus into the stomach to view the pathology. Endoscope can make a J-turn in order to view the gastroesophageal junction and the fundus. It can also take small biopsy samples, which are then sent for histological examination and to identify Helicobacter pylori.

Urea breath test – this test does not require EGD and is used to identify Helicobacter pylori. This test is based upon the ability of Helicobacter pylori to transform urea into carbon dioxide and ammonia. To conduct this test, the patient is asked to swallow urea which was labeled with either non-radioactive carbon-13 or radioactive carbon-14. After 10-30 minutes the patient exhales in a special device, which can detect if the breath contains carbon-13 or -14 isotopes. If the device detects either of those isotopes, then the patient is infected by Helicobacter pylori. Urea breath test is recommended as a way to detect Helicobacter pylori before and after the treatment.

Histological examination of EGD biopsy – this method is very important due to the fact that long-existing, large gastric ulcers (especially the ones located on the large curvature of the stomach) are a precancerous condition. Thus, it is very important to take biopsy simples when performing EGD all around the ulcer, to ensure that there is no malignant growth within the walls of the stomach. This method is used for detecting cancer cells long before any other symptoms will start to appear, which ensures a very high chance of success during the cancer treatment.

Less common methods for making a diagnosis

Barium contrast X-rays – due to the fact that to use this method the patient has to be exposed to certain amount of radiation and the wide availability of high quality endoscopes, this method is used more rarely with each passing year. During this process the patient drinks a barium liquid, which is opaque to X-rays, and then X-ray images are taken.

Test for Helicobacter pylori using biopsy samples from EGD – this test is similar to urea breath test. Rapid urease test is used on biopsy samples taken through gastroscopy to detect if Helicobacter pylori infection is present. Even though the sensitivity of this test is higher than that of the urea breath test, it is used less frequently since it requires biopsy samples to be taken.

Blood antibody test – allows determining whether a person has IgG and IgM antibodies to Helicobacter pylori due to being infected in the past or present. The levels of IgM antibodies rise 2-4 weeks after the patient was infected. On the other hand IgG antibodies rise only 2 months after the patient was infected and remain in the bloodstream throughout his or her entire life. Even though this test is good for screening, it is impossible to tell whether the patent is currently infected or if the patent was infected in the past and still has antibodies to Helicobacter pylori. This test is also useless when assessing the effectiveness of treatment. Moreover, without EGD verification or urea breath test, this test is not considered to be enough to start the treatment using antibiotics.

Stool antigen test – involves examination of the patient’s feces to determine whether they contain antigens of Helicobacter pylori. This test uses anti-Helicobacter pylori antibodies as the capture antibody and peroxidase-conjugated anti-Helicobacter pylori antibodies as the detection antibody. Depending on how intense the coloring of the solution is, the results are reported as detected, undetected, or indeterminate.