How Peptic Ulcer Disease Is Diagnosed

There are several ways peptic ulcer disease is diagnosed—including blood and breath tests, stool testing, an endoscopy, and an upper gastrointestinal series.

This article discusses each type of test that may be ordered by your healthcare provider to diagnose a peptic ulcer.

Labs and Tests

Your healthcare provider will begin with a physical exam before ordering tests for peptic ulcer disease. They may:

• Check for bloating and stomach tenderness 
• Ask about your symptoms 
• Review your lifestyle and health history, including recent medications

Several tests can help diagnose peptic ulcer disease.

Blood Test

A blood sample can determine whether you have a Helicobacter pylori (H.pylori) infection that is causing a peptic ulcer. The test will measure antibodies (infection-fighting cells) to H. pylori.

Depending on the medical practice, your blood may be drawn in the healthcare provider’s office at the same visit as your physical exam or at a separate facility that handles blood testing.

Urea Breath Test

The urea breath test checks for an H. pylori infection. Here’s how it works:

• You blow into a balloon-like bag to measure carbon dioxide in your breath 
• Swallow a capsule, liquid, or pudding containing urea, then wait a few minutes 

Blow into the bag again to check carbon dioxide levels

If H. pylori is present, it converts the urea into carbon dioxide, increasing levels in your exhaled breath. A higher level on the second test indicates a positive result for H. pylori.

Stool Test

H. pylori can also be detected in fecal matter (poop) through a stool sample that is analyzed by a lab. The urea breath test and stool test are typically more accurate than the blood test in identifying the presence of H. pylori.

Biopsy

During an endoscopy, a tissue sample (called a biopsy) is taken from the stomach lining and analyzed in a lab.

The procedure is done in the hospital or at an outpatient center. Usually, a biopsy is done if endoscopy is needed for other reasons, such as diagnosing the ulcer, treating bleeding, or making sure there is no cancer.

Imaging

If the cause of peptic ulcers isn’t related to H. pylori, your healthcare provider may perform some imaging tests in order to see the contents of your stomach and intestine. These may include:

Endoscopy

An endoscopy involves inserting a small tube with a camera, called an endoscope, into your throat to view your esophagus, stomach, and small intestine. This helps a gastroenterologist look for abnormalities.

If ulcers are found, you’ll receive treatment, and a follow-up endoscopy will ensure they have healed properly. Typically, this procedure is done at an outpatient facility, and you’ll receive sedation through an IV for comfort.

Upper Gastrointestinal Series

Commonly referred to as a barium swallow, this imaging test is performed if someone is experiencing severe peptic ulcer symptoms, like stomach pain with vomiting, weight loss, or difficulty swallowing.

Barium sulfate is a metallic compound and drinking a small amount of it will let a gastroenterologist see your digestive tract via X-ray, which will show any presence of peptic ulcers.

CT Scan

For a CT scan, you’ll drink a solution called a contrast medium and lie on a table that moves into a tunnel-shaped machine. This machine takes X-ray images of your stomach and small intestine.

CT scans can reveal damage from peptic ulcers, such as stomach lining erosion.

Differential Diagnoses

Your healthcare provider may also consider other causes for your symptoms. These conditions, however, won’t show ulcers on the endoscopy.

• Esophagitis can cause similar symptoms to peptic ulcer disease, and one condition that contributes to it, gastroesophageal reflux disease (GERD), is another suspect.
• Gastritis is inflammation of the stomach lining, which might be due to H. pylori or other causes and is sometimes a precursor to peptic ulcer disease.
• Gastric cancer may also need to be ruled out.
• Non-ulcer dyspepsia is a recurring stomach pain that has no obvious cause. While some of these cases may be from mild H. pylori, in these cases, symptoms can be managed through medication and lifestyle changes and have no serious health consequences in the long-run.