Peptic Ulcers - Diagnosis

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Endoscopy

Endoscopy (also called esophagogastroduodenoscopy or EGD) is a procedure used to evaluate the esophagus, stomach, and duodenum using an endoscope -- a long, thin tube equipped with a tiny video camera. When combined with a biopsy, endoscopy is the most accurate procedure for detecting the presence of peptic ulcers, bleeding, and stomach cancer, or for confirming the presence of H. pylori.

Appropriate Candidates for Endoscopy. Because endoscopy is invasive and expensive, it is unsuitable for screening everyone with dyspepsia. Endoscopy is usually reserved for patients with dyspepsia who also have risk factors for ulcers, stomach cancer, or both.

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Endoscopy is recommended for:

• Patients over age 50 who have new dyspepsia symptoms
• Patients of any age who have "alarm" symptoms (unexplained weight loss, gastrointestinal bleeding, vomiting, difficulty swallowing, or anemia)

Patients under age 50 who don't have alarm symptoms may be tested non-invasively for H. pylori and treated for the infection if they test positive.

The decision about whether endoscopy should be performed on patients who do not respond to initial medication should be individualized. Endoscopy may be recommended for patients with gastric ulcers who continue to have symptoms despite treatment, or for those who have ulcers without a clear cause. It should also be done before surgery is considered.

The Procedure. Endoscopy may be performed in a hospital, doctor's office, or outpatient surgery center, and typically involves the following:

• The doctor administers a local anesthetic using an oral spray and an intravenous sedative to suppress the gag reflex and relax the patient.
• The doctor then places a thin, flexible plastic tube into the patient's mouth and maneuvers it down the esophagus into the stomach.
• A tiny camera in the endoscope allows the doctor to see the surface of the esophagus, stomach, and duodenum, and search for abnormalities.
• The doctor will remove about 10 small tissue samples (biopsies), which will be tested for H. pylori.