Peptic Ulcer Disease - Exams and Tests

Exams and Tests

The tests needed to diagnose peptic ulcer disease may depend on your symptoms and on a medical history and physical exam.

If you are a younger adult who is having ulcer symptoms for the first time, your health professional may begin treatment with medications based only on your symptoms and the results of your medical history and physical exam. However, it is becoming more common to test immediately for Helicobacter pylori (H. pylori) infection whenever someone has ulcerlike symptoms.

If you are older than 45, you may require more extensive testing because you may be at increased risk for stomach cancer. Although the risk of stomach cancer is small, it is important to distinguish between a gastric and duodenal ulcer. If you have a stomach ulcer, it will be tested for cancer. In rare cases, stomach ulcers contain cancer cells. Additional testing is needed especially for those people older than 45 who have:

• Ulcer symptoms for the first time.
• Ulcer symptoms that return before or after treatment is completed.
• A family history of stomach cancer.
• Additional symptoms that may indicate a more serious problem, such as stomach cancer. These include:³
  • Blood in the stool.
  • Weight loss of more than 10% of body weight.
  • Anemia.
  • Difficulty swallowing (dysphagia).
  • Jaundice.
  • Abdominal mass.
  • Anorexia.

Tests to diagnose peptic ulcer disease

When a person has symptoms of a peptic ulcer, the following tests are used:

• Upper gastrointestinal (UGI) series. An X-ray exam of the esophagus and stomach (upper GI series) may be used to diagnose peptic ulcer disease, although this test is being used less frequently.
• Endoscopy.Endoscopy allows the doctor to look at the inside of the stomach and upper small intestine to see whether ulcers are present. It also allows the doctor to collect a tissue sample (biopsy) that can be tested for the presence of H. pylori bacteria or other problems (such as cancer) in the stomach.

A fecal occult blood test (FOBT) may be done to detect blood in the stool, which may be caused by a peptic ulcer or another serious problem, such as colon cancer. By itself an FOBT cannot diagnose peptic ulcer disease, but it may indicate if an ulcer is bleeding.

A complete blood count (CBC) also may be done to look for anemia, which may be caused by a bleeding ulcer.

Tests for H. pylori infection

Many people are infected with H. pylori bacteria, but most of them will not develop symptoms of peptic ulcer disease. Because of this, testing for H. pylori infection is recommended only in people who:⁴

• Have active peptic ulcer disease or a past history of a peptic ulcer.
• Are known to have or have a family history of stomach cancer or another condition called mucosa-associated lymphoid tissue (MALT).
• Have a new case of dyspepsia.
• Are willing to begin treatment if bacteria are found.

However, some doctors prefer to test for H. pylori infection in everyone who has ulcerlike symptoms.

Your doctor may recommend a screening for H. pylori before long-term NSAID use is begun. Screening and treatment for H. pylori infection has been shown to reduce the risk of ulcers for people starting long-term NSAID use.⁵ Anyone taking NSAIDs should discuss the potential risks of long-term NSAID use with his or her health professional.

Helicobacter pylori tests cannot diagnose peptic ulcer disease or other conditions that may cause symptoms similar to an ulcer. These tests can only determine whether H. pylori bacteria are present. The most common tests used to detect an infection with H. pylori bacteria include:

• Biopsy of the stomach lining. During an upper endoscopy exam, a biopsy of the stomach lining will be collected to test for H. pylori bacteria. A biopsy is the most accurate way to test for H. pylori. It also allows the doctor to check for other possible causes of symptoms (such as cancer). A biopsy is expensive and requires an upper endoscopy exam, which is more invasive than other tests used to detect H. pylori.
• Blood test for H. pylori antibodies. A blood test for H. pyloriantibodies is a quick, easy, and inexpensive test to detect them. This blood test may make it possible to avoid having an upper endoscopy exam. However, it cannot distinguish between a past or current infection with H. pylori bacteria; therefore, it is not useful for determining whether an infection has been cured.
• Urea breath test. A urea breath test for H. pylori is very accurate. Unlike the blood test, it will detect only those H. pylori bacteria that are present at the time of the test. This makes it a good test for checking to see whether an H. pylori infection has been cured. The test is somewhat expensive.
• Stool antigen test. This test checks for antigens for H. pylori in the stool. It can be used to diagnose H. pylori bacteria as a cause of peptic ulcer disease and to see whether treatment has eliminated the infection.

Some people who have received therapy with medications to treat an H. pylori infection need follow-up testing to ensure that the infection is cured.