Until 1970, peptic ulcers were diagnosed almost exclusively by using an X-ray technique known as an upper GI (gastrointestinal) series: Patients drink a barium solution to coat the upper digestive tract that makes ulcers visible to the radiologist. The test is still widely used, but additional tests make for more refined diagnosis of underlying causes, which allows more targeted treatment.
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Barium X-ray, or an upper GI (gastrointestinal) series, is a widely available and accepted method for diagnosing peptic ulcer disease in the stomach or duodenum, the upper part of the small intestine. After drinking barium, a thick white solution that coats the inside of the stomach and duodenum,the patient is X-rayed. The barium allows the radiologist to spot ulcers.
However, an upper GI series is less accurate at defining the exact nature of the disease—for example, at distinguishing benign from malignant ulcer disease—than is endoscopy, which snakes a tiny camera into the digestive tract. And in patients who have anatomic deformities from previous gastric surgery or scarring from chronic inflammation, barium X-rays may be difficult to interpret. Generally, these X-rays have up to a 30 percent false negative rate—that is, they don't reveal disease in almost onethird of people who have the disease.
EGD is the most direct and accurate method for diagnosing peptic ulcer disease. It allows the physician to visualize and biopsy the upper gastrointestinal tract including the esophagus, stomach, and duodenum. The test involves use of an endoscope, a thin, flexible, lighted tube with a tiny camera on the end of it, which is passed through the mouth and pharynx and into the esophagus. The patient is placed on his or her left side and given a numbing agent to help prevent gagging. Pain medication and a sedative may also be administered during the procedure.
During the test, the endoscope transmits an image of the esophagus, stomach, and duodenum to a monitor visible to the physician. Air may be introduced into the stomach, expanding the folds of tissue, and enhancing examination. The endoscope also allows visualization of up to 50 percent of the small intestine.
In addition to identifying the ulcer, its location and size, EGD also provides an opportunity to biopsy subtle mucosal lesions. Endoscopic biopsies are indicated for all stomach ulcers because of the risk of underlying cancer. By contrast, duodenal ulcers, which are always benign, do not require biopsy. Endoscopic biopsy is also the gold standard for diagnosing H. pylori infection. New testing methods can determine the presence of H. pylori in a biopsied tissue sample within three hours and are 90 percent accurate.
If an ulcer is discovered, your doctor will run further tests to see if you've been infected with H. pylori bacteria, a major cause of peptic ulcer. A positive result would indicate that you should be treated with antibiotics.
The most accurate test for H. pylori involves analyzing under the microscope tissues sampled in an endoscopic biopsy of the stomach to detect the bacterium directly.
Other less invasive tests are described below:
A simple blood test can determine whether the bacteria are or were present by detecting antibodies in the blood. Unfortunately, it will indicate only whether you've been exposed, not whether the infection has been cured.
A urea breath test, by contrast, can demonstrate if antibiotic treatment for the bacteria has been successful. This simple, noninvasive test is based on the ability of H. pylori to break down urea, a chemical made of nitrogen and carbon that normally is produced by the body and excreted in the urine.
For the test, patients swallow a solution containing urea made from an isotope of carbon. (Isotopes of carbon occur in minuscule amounts in nature and can be measured with special testing machines.) If H. pylori is present in the stomach, the urea is broken up into nitrogen and carbon (as carbon dioxide). The carbon dioxide is absorbed across the lining of the stomach and into the blood. It then is excreted from the lungs in the breath. Samples of exhaled breath are collected. If the isotope is detected in the breath, it means that H. pylori is present in the stomach. When the H. pylori is effectively treated with antibiotics, the test for the isotope is negative.
The most recent noninvasive test is the stool antigen test, in which a stool sample is analyzed for evidence of the bacterium. This test is also useful for checking whether antibiotic treatment of a H. pylori infection has been successful.
When ulcers do not heal with therapy, or when they keep recurring, gastric acid analysis can determine whether the disease is caused by excessive secretion of stomach acid. After the patient fasts overnight, a lubricated rubber tube is passed into his or her stomach by mouth or through the nasal passage. With the patient in a sitting position, the initial stomach contents are suctioned out. Then stomach contents are sampled every 15 minutes for a period of 60 minutes.
For the test to be accurate, doctors will instruct patients to withhold any antacids, anticholinergics, cholinergics, alcohol, H2-receptor blockers (Tagamet, Pepcid, Zantac), reserpine, adrenergic blockers, and adrenocorticosteroids for three to seven days before the test. Complications such as nausea, vomiting, and abdominal distention or pain are possible following removal of the gastric tube.
Patients who do not respond to therapy for peptic ulcer disease within eight weeks, or those with recurrent ulcers, should take the precaution of having their blood checked for levels of calcium and gastrin, a hormone that stimulates secretion of acid in the stomach. These readings can help doctors determine whether symptoms are the result of a tumor in the pancreas, duodenum, or elsewhere.
Last reviewed on 7/28/09
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