How are peptic ulcers diagnosed?

Initial approach when a peptic ulcer is suspected
Before embarking on extensive testing, doctors usually scrutinise a patient's medical and family history as well as his/her current lifestyle. Questions about eating habits, smoking and drinking,and use of any other medication, especially non-steroidal anti-inflammatories, may be asked.

Acid-blocking medication may be prescribed for four weeks as an initial treatment. Many ulcers may heal within this period of time. If not, further testing may be needed.

Tests for Gastrointestinal bleeding may be performed. This consists of a rectal examination, a complete blood count test and a faecal occult blood test, used to detect hidden blood.

Your doctor may suspect a peptic ulcer when he or she notes your symptoms, but because the symptoms of the different ulcers are much alike, several tests may be ordered if the above three initial steps have not made it possible to make a specific diagnosis.

Barium X-rays
For diagnosing a stomach ulcer, your doctor may request a barium X-ray of your upper gastrointestinal tract. This is not at all uncomfortable and involves no risk. You swallow barium, a white chalky substance that is visible on X-ray (it is sometimes called a "barium milkshake") and are asked to lie down on a tilted examining table. The tilting distributes the barium evenly around your upper digestive tract and the X-ray can capture images at different angles. This allows the doctor to locate the ulcer, and to determine its type and severity. This is not a very accurate procedure: in almost 20 percent of cases these X-rays do not detect ulcers.

Endoscopy or gastroscopy
A more accurate procedure is an upper endoscopy or gastroscopy. You are sedated and a slim, flexible lighted tube is inserted through your mouth to examine the stomach, oesophagus and duodenum. During the procedure the doctor can also take a biopsy of skin tissue to test for H. pylori infection. Biopsies, especially of stomach or gastric ulcers that may be cancerous, can be examined under a microscope to determine if cancer is present.

Blood tests
The doctor may also order a blood test to check for anaemia (indicative of internal bleeding), an analysis of a stool sample to check for blood (indicating a bleeding ulcer) or other blood tests to check for the presence of H. pylori bacteria. H.pylori can also be diagnosed by a breath test.

Other tests for H.Pylori
New tests are under investigation including a saliva test and one known as PCR – polymerase chain reaction, that uses cells from gums or stools and makes multiple copies of the DNA of H. Pylori until the bacteria is detected.

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