Though not all stomach ulcers or peptic ulcers are caused by H. pylori, it has become customary to test for the presence H. Pylori bacteria in the diagnosis of peptic ulcer disease.
Peptic ulcer is a composite name given to three types of ulcers:
- The esophageal ulcer, which occurs in the esophagus. This is the food pipe.
- The stomach or the gastric ulcer found in the stomach
- The duodenal ulcer, which occurs in the duodenum. This is the uppermost part of the small intestine, which starts from the lower end of the stomach
The criteria for the diagnosis of a peptic ulcer consists 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).
Diagnosing Peptic Ulcer
1) Endoscopy for diagnosis of ulcer
This is the diagnostic test for peptic ulcer disease. The presence of a peptic ulcer is confirmed with the help of an instrument called the endoscope (also called the gastroscope). This instrument consists of a narrow flexible tube fitted with a telescopic lens and camera.
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. The biopsy can also be performed and the sample of the tissue taken, can be sent to the histopathology laboratory to test for presence of H. pylori bacteria and to rule out malignancy, especially in people older than 55 years.
2) Test for diagnosing presence of H. Pylori
Urea breath test
The patient is given a liquid to drink which 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.
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 raise the possibility of a bleeding ulcer.
3) 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 and 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 wall.