Peptic Ulcers - Diagnosis

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

Dyspepsia may also occur with gastritis, stomach cancer, or as a side effect of certain drugs, including NSAIDs, antibiotics, iron, corticosteroids, theophylline, and calcium blockers.

Noninvasive Tests for Gastrointestinal (GI) Bleeding

When ulcers are suspected, the doctor will order tests to detect bleeding. These may include a rectal exam, complete blood count, and fecal occult blood test (FOBT). The FOBT tests for hidden (occult) blood in stools. Typically, the patient is asked to supply up to six stool specimens in a specially prepared package. A small quantity of feces is smeared on treated paper, which is then exposed to hydrogen peroxide. If blood is present, the paper turns blue.

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Tests to Detect H. pylori

Simple blood, breath, and stool tests can detect H. pylori with a fairly high degree of accuracy.

Experts recommend testing for H. pylori in all patients with peptic ulcer disease, because it is such a common cause of this condition.

Smokers and those who experience regular and persistent pain on an empty stomach may also be good candidates for screening tests.

Some doctors argue that testing for H. pylori may be beneficial for patients with dyspepsia who are regular NSAID users. Given the possible risk for stomach cancer in H. pylori- infected people with dyspepsia, some experts now recommend that any patient with dyspepsia lasting longer than 4 weeks should have a blood test for H. pylori. This is a subject of considerable debate, however.

Tests for Diagnosing H. pylori. The following tests are used to diagnose H. pylori infection. Testing may also be done after treatment to ensure that the bacteria have been completely eliminated.

Breath Test. A simple test called the carbon isotope-urea breath test (UBT) can identify up to 99% of people who have H. pylori. Up to 2 weeks before the test, the patient must stop taking any antibiotics, bismuth-containing medications such as Pepto-Bismol, and proton pump inhibitors (PPIs). As part of the test, the patient swallows a special substance containing urea (a waste product the body produces as it breaks down protein) that has been treated with carbon atoms. If H. pylori are present, the bacteria convert the urea into carbon dioxide, which is detected and recorded in the patient's exhaled breath after 10 minutes. This test can also be used to confirm that H. pylori have been fully treated.
Blood Tests. Blood tests are used to measure antibodies to H. pylori, and the results are available in minutes. Diagnostic accuracy is reported to be 80 - 90%. One such important test is called enzyme-linked immunosorbent assay (ELISA). An ELISA test of the urine is also showing promise for diagnosing H. pylori in children.
Stool Test. A test to detect the genetic traces of H. pylori in the feces appears to be as accurate as the breath test for initially detecting the bacteria, and for detecting recurrences after antibiotic therapy. This test can also be used to confirm that the H. pylori infection has been fully treated.
The most accurate way to identify the presence of H. pylori is by taking a tissue biopsy from the lining of the stomach. The only way to do this is with endoscopy, which is an invasive procedure. However, many patients are treated for H. pylori based on the three noninvasive tests listed above.