The process of diagnosing a peptic ulcer begins with your doctor first taking a medical history and performing a physical exam. You then may need to undergo certain diagnostic tests and procedures,

Though not all peptic ulcers are caused by H. pylori, it has become customary to test for the presence of H. Pylori bacteria in the diagnosis of peptic ulcer disease.

A peptic ulcer is a composite name given to three types of ulcers:

  • The esophageal ulcer occurs in the esophagus. This is the food pipe.
  • The stomach or the gastric ulcer found in the stomach
  • The duodenal ulcer occurs in the duodenum. This is the uppermost part of the small intestine, which starts from the lower end of the stomach

Diagnosis of peptic ulcer

The criteria for the diagnosis of a peptic ulcer consist of three tests

  • Use of an endoscope to view the ulcer directly,
  • A breath analyzer test
  • The testing of the blood and stools to detect the presence of H. pylori (Helicobacter pylori).

Besides, your doctor will take a detailed medical history and perform a physical examination.

Medical history

To help diagnose a peptic ulcer, your doctor will ask you questions about your medical history, your symptoms, and the medicines you may be taking such as nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin (Bayer Aspirin), ibuprofen (Motrin, Advil), and naproxen (Aleve).

He will ask about your eating and lifestyle habits and whether your diet conforms to the dietary standards  for peptic ulcer

Physical Exam

Through a physical exam, your doctor may look for the certain signs:

  • whether your abdomen is bloated
  • He listens for sounds within your abdomen using a stethoscope
  • He palpates your abdomen checking for tenderness or pain. The epigastric pain or tenderness is a classic sign of a peptic ulcer.

Endoscopy for diagnosis of ulcer

This is the confirmatory diagnostic test for peptic ulcer disease. Your gastrointestinal surgeon confirms the presence of a peptic ulcer with the help of an instrument called the endoscope (also called the gastroscope) to view your stomach and the duodenum. This instrument consists of a narrow flexible tube fitted with a telescopic lens and camera.

You will be given a sedative through the vein. Your doctor will also spray an anesthetic on the back of your throat. This will help you stay relaxed and comfortable during the procedure.

The endoscope is passed through the mouth into the stomach and duodenum. The inside of the stomach is viewed directly. With the help of the inbuilt camera in the endoscope, pictures or a video can also be taken.

The sight of an ulcer confirms the diagnosis. Endoscopy is performed in an operation theater with the necessary sterile precautions.

A biopsy can also be performed and the sample of the tissue taken will be sent to the histopathology laboratory to test for the presence of H. pylori bacteria and to rule out malignancy, especially in people older than 55 years.

Your doctor is more likely to recommend endoscopy if you are more than 45 years old, have signs of bleeding, have undergone recent weight loss, or have persistent vomiting after eating meals.

Tests for diagnosing the presence of H. Pylori

Urea breath test

The patient is given a liquid to drink that contains urea. In the stomach, H. pylori, if present, breaks down the urea into water and carbon dioxide.

With the help of the breath analyzer machine, the breath is tested for levels of carbon dioxide. Normally, carbon dioxide is present in our expelled breath, but the presence of carbon dioxide beyond a certain level confirms the presence of H. Pylori in your stomach or the small intestine.

Blood and stool tests

Alternatively, blood and stools are tested for the presence of H. Pylori.

  • Occult blood in stools can point to the possibility of a bleeding ulcer.
  • The complete blood count may show anemia, which can again raise the possibility of a bleeding ulcer.

Barium X-ray of the stomach and duodenum

The barium meal x-ray can detect an ulcer, but this radiological test is not used much now. In this radiological test, the patient is given radio-opaque liquid barium to swallow.

X-rays are taken as the barium descends down into the esophagus, the stomach, and the duodenum. The ulcer shows a crater-like appearance on the inner stomach or the duodenal wall, which seals the diagnosis of a peptic ulcer.

Computerized tomography (CT) scan

For a CT scan, you may be given a solution to drink and an injection of a special dye, which is a contrast medium. You do not need anesthesia for this procedure.

The radiologist interprets the CT scan images. The scan can help diagnose peptic ulcer complications such as a perforation that has created a hole in the wall of your stomach or duodenum.