Peptic ulcers: diagnosis and tests
Your doctor may suspect a peptic (stomach) ulcer from the symptoms you have, but may not be able to determine whether it is a gastric ulcer (within the main part of the stomach) or a duodenal ulcer (in the duodenum, just after the stomach) from the symptoms alone. As the symptoms of gastric and duodenal ulcers can be similar, your doctor may need to use tests to determine if you have an ulcer and what sort it is.
Peptic ulcers can be diagnosed in several ways.
Gastroscopy or endoscopy
Gastroscopy (upper gastrointestinal endoscopy) involves the use of a thin, flexible lighted tube, called an endoscope, which is eased through your mouth and down the throat to give your doctor a direct view of the inside of your oesophagus (gullet), stomach and duodenum. The procedure is done under light sedation and is usually painless and safe. Your doctor may use the endoscope to take photographs of the ulcer area. The endoscope can also be used to remove tissue samples (biopsies). These samples may then be tested for the presence of Helicobacter pylori (H. pylori), a bacterium that can be associated with ulcers, or examined to eliminate the possibility of cancer.
An upper gastrointestinal (GI) series
This is a series of X-rays of the stomach and duodenum that helps the doctor locate an ulcer and determine its type and how serious it is. You will be required to drink a chalky liquid containing barium that will highlight the upper digestive tract so that it shows up on the X-ray. The solution will pool in any ulcer cavities and show up on the X-ray.
Helicobacter pylori testing
There are other tests that can be done to determine if H. pylori is present. These include the following.
Under normal circumstances, if you are infected with H. pylori your immune system will recognise that the bacterium is foreign to your body and will produce antibody to it. The blood test for H. pylori detects antibody to the bacterium and so shows whether you have H. pylori present in your body or have had recent infection with it. However, even if the test is positive it does not mean that you have an ulcer and you may not have any symptoms of the infection. Your doctor will be able to advise you if you should undergo further examination.
This test uses the fact that H. pylori contains the enzyme urease, which breaks down urea in the stomach to ammonia and carbon dioxide. In the test you swallow a special urea solution or capsule which is chemically ‘labelled’ so that it can be traced later. If you have H. pylori in your stomach it will break down the labelled urea into ammonia and carbon dioxide. Because the carbon dioxide will be labelled it can be detected in your breath for a short time. This test is very accurate. Breath tests involving non-radioactive urea are preferred for children, or women who are pregnant.
Your doctor will advise you whether you need to be tested for H. pylori and, if so, which test is most appropriate.
Although H. pylori infection may increase the risk of some forms of cancer of the stomach, only a small minority of people with the infection ever develops such cancer. Stomach cancer is becoming uncommon in Australia as the number of people infected with H. pylori declines.
Sometimes, peptic ulcers may also be diagnosed during surgery. The surgery is often emergency surgery required because an ulcer which has previously not caused any symptoms has suddenly developed complications. The ulcer may have perforated (bored through the duodenal or stomach wall), penetrated (gone through the wall and penetrated a neighbouring organ, such as the liver) or obstructed the stomach outlet or duodenum, or it may be bleeding.