How Peptic Ulcer Disease Is Diagnosed

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Peptic ulcer disease (also referred to as stomach ulcers) are sores that develop on the lining of your stomach or small intestine. There are several ways to diagnose peptic ulcer disease, ranging from blood tests, stool testing, an endoscopy, and an upper gastrointestinal series.

Self-Checks and At-Home Testing

You may suspect you have peptic ulcer disease if you experience stomach burning, bloating, heartburn, and nausea. Stomach burning is considered to be the most prevalent symptom of peptic ulcer disease, and you’ll notice it’s worse on an empty stomach, between meals, or at night. Certain acid-reducing medication may temporarily relieve symptoms but may return—especially if you smoke or use nonsteroidal anti-inflammatory drugs like ibuprofen often—which is typically a red flag that you may be dealing with peptic ulcer disease as opposed to general heartburn.

There are also some less common but more severe symptoms to keep in mind as you monitor yourself for peptic ulcer disease. These include changes in appetite, unexplained weight loss, vomiting with traces of blood, and dark blood in stools. Some people may also feel faint and have trouble breathing. If you notice any of these signs it’s important to call your doctor immediately.

While it used to be thought that stress and spicy foods were among the triggers for ulcers, it is now known that a bacterial infection or long-term use of pain relievers are the most common causes. However, stress or certain foods can make symptoms of already established peptic ulcers worse—or possibly mask them as the cause if you haven’t been diagnosed with peptic ulcer disease yet.

Labs and Tests

Your doctor will start with a physical exam before diving into specific tests to diagnose peptic ulcer disease. Here they will examine you for any bloating and stomach tenderness. Depending on your symptoms, lifestyle, and health history (including list of current or recent medications you’ve taken) there are a number of tests doctors can run, which may include one or more of the following:

  • Blood test: A blood sample will let the doctor see if you’re experiencing peptic ulcers from a Helicobacter pylori infection. Depending on the practice, this may be taken at the same visit as your physical exam in the doctor’s office or at a separate facility that handles blood testing.
  • Urea breath test: Also done in order to test for an H. pylori infection, this test involves drinking a urea liquid—a waste product your body produces in order to break down amino acids. If you have H. pylori in your body, it will turn the liquid into carbon dioxide, which appears in an exhaled breath. By drinking the liquid and then breathing into a bag, lab testing can be done to determine if you have higher levels of carbon dioxide than normal, which would point to an H. pylori infection.
  • Stool test: A lab can also detect H. pylori in fecal matter via stool sample. Urea breath tests and stool tests are typically the most accurate in being able to pinpoint an H. pylori presence that may be causing peptic ulcers.  

Imaging

If the cause of peptic ulcers isn’t related to H. pylori your doctor may perform some imaging tests in order to see the contents of your stomach and intestine. These may include:

  • Endoscopy: A small tube with a lens (called an endoscope) is inserted into your throat to view your esophagus, small intestine, and stomach. This will help a gastroenterologist look for abnormalities in the upper digestive system. If any ulcers are present, you’ll be given treatment for your peptic ulcers and another endoscopy will be performed after treatment to make sure the ulcers have healed properly. This procedure is typically performed in an outpatient facility and you’ll be sedated through an IV to help you stay relaxed and comfortable.
  • Upper gastrointestinal series: Commonly referred to as a barium swallow, this imaging test is performed if someone is experiencing severe peptic ulcer symptoms, like stomach pain with vomiting, weight loss, or difficulty swallowing. Barium sulfate is a metallic compound and drinking a small amount of it will let a gastroenterologist see your digestive tract via X-ray, which will show any presence of peptic ulcers.
  • CT scan: Drinking a solution called a contrast medium, you’ll lay on a table that slides into a tunnel to take X-ray photos of your stomach and small intestine. This is a good way to see any damage peptic ulcers may have caused, such as holes in the stomach due to erosion.

Differential Diagnoses

Your doctor may also consider other causes for your symptoms. These conditions, however, won't show ulcers on the endoscopy.

  • Esophagitis can cause similar symptoms to peptic ulcer disease, and one condition that contributes to it, gastroesophageal reflux disease (GERD), is another suspect.
  • Gastritis is inflammation of the stomach lining, which might be due to H. pylori or other causes and is sometimes a precursor to peptic ulcer disease.
  • Gastric cancer may also need to be ruled out.
  • Nonulcer dyspepsia is a recurring stomach pain that has no obvious cause. While some of these cases may be from mild H. pylori, in these cases symptoms can be managed through medication and lifestyle changes and have no serious health consequences in the long-run.

A Word From Verywell

It's important to speak to your doctor or health care provider if you think you may have peptic ulcer disease in order to get an accurate diagnosis. Peptic ulcer disease may be easy to self-diagnose because of its tell-tale symptoms but requires proper medical treatment in order to be effectively managed. It's possible to minimize or completely eliminate peptic ulcer disease and its symptoms through several interventions, all of which are dependent on your complete health history and the root cause of your stomach ulcers.

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Article Sources

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  1. National Institute of Diabetes and Digestive and Kidney Diseases. Diagnosis of peptic ulcers (stomach ulcers). Updated November 2014.

  2. National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms & Causes of Peptic Ulcers (Stomach Ulcers). Updated November 2014.

  3. Fashner J, Gitu AC. Diagnosis and treatment of peptic ulcer disease and H. pylori infection. Am Fam Physician. 2015;91(4):236-242.

  4. Medical University of South Carolina. Non-Ulcer Dyspepsia.

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