Peptic Ulcers - Diagnosis

Highlights	Risk Factors	Lifestyle Changes
Introduction	Diagnosis	Resources
Causes	Treatment	References
Symptoms	Medications	References
Complications	Surgery

Diagnosis

Peptic ulcers are always suspected in patients with persistent dyspepsia (bloating, belching, and abdominal pain). Symptoms of dyspepsia occur in 20 - 25% of people who live in industrialized nations, but only about 15 - 25% of those with dyspepsia actually have ulcers. It takes several steps to accurately diagnose ulcers.

Medical and Family History

The doctor will ask for a thorough report of a patient's dyspepsia, as well as:

Other important symptoms, such as weight loss or fatigue
Present and past medication use (especially long-term NSAID use)
Family members with ulcers
Drinking and smoking habits

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Ruling out Other Disorders

Many other conditions, including gastroesophageal reflux disease (GERD) and irritable bowel syndrome, cause dyspepsia.

Peptic ulcer symptoms, particularly abdominal pain and chest pain, may resemble the symptoms of other conditions, including:

GERD. About half of patients with GERD also have dyspepsia. With GERD or other problems in the esophagus, the main symptom is usually heartburn, a burning pain that radiates up to the throat. It typically develops after meals and is relieved by antacids. The patient may have difficulty swallowing and may experience regurgitation or acid reflux. Elderly patients with GERD are less likely to have these symptoms, but instead may have appetite loss, weight loss, anemia, vomiting, or dysphagia (difficult or painful swallowing). [For more information, see In-Depth Report #85: Gastroesophageal reflux disease.]
Heart Problems. Heart pain, such as from angina or a heart attack, is more likely to occur with exercise and may radiate to the neck, jaw, or arms. In addition, patients typically have distinct risk factors for heart disease, such as a family history, smoking, high blood pressure, obesity, or high cholesterol. [For more information, see In-Depth Report #12: Heart attack.]
Gallstones. The primary symptom in gallstones is a steady gripping or gnawing pain on the right side under the rib cage, which can be severe and can radiate to the upper back. Some patients experience pain behind the breastbone. The pain often occurs after a fatty or heavy meal, but gallstones almost never cause dyspepsia. [For more information, see In-Depth Report #10: Gallstones and gallbladder disease.]
Irritable Bowel Syndrome. Irritable bowel syndrome can cause dyspepsia, nausea and vomiting, bloating, and abdominal pain. It occurs more often in women than in men.