Ulcers - Diagnosis

The first indication of an ulcer is likely to be a patient's complaint about one or more of the described symptoms. When a patient visits a physician for diagnosis, a physical examination alone is not enough. A doctor will look for certain factors in the patient's history that may suggest the presence of an ulcer. These factors include:

• If the patient is male
• Age over forty-five
• Recent weight loss, bleeding, repeated episodes of vomiting, back pain, or anemia
• History of using aspirin or other NSAIDs
• History of heavy smoking
• Family history of ulcers or stomach cancer

Endoscopy (pronounced en-DOS-kuh-pee) is one of the best ways to diagnose an ulcer. An endoscope consists of a long, narrow tube that can be inserted down the patient's throat. The tube contains a light and a tiny camera at one end. The doctor can actually look at the interior walls of the stomach and duodenum. If necessary, tiny scissors may also be attached to the endoscope. The scissors can be used to cut off a small sample of mucous membrane, which can be examined for the presence of stomach cancer. About 5 percent of ulcers develop into stomach cancer.

Imaging techniques can also be used to diagnose ulcers. These techniques are not as reliable as endoscopy but they are more comfortable for the patient. Imaging requires the patient to drink a fluid containing a substance that is opaque, or nontransparent, to X rays. An X-ray photograph is then taken of the patient's digestive system. The opaque substance appears as a white patch on the photograph and shows any abnormal structures, such as an ulcer, that may be present.

Blood tests are usually not very helpful in diagnosing ulcers. However, they may indicate when a patient has become anemic because of a bleeding ulcer.

The most important laboratory tests to perform are those that detect the Helicobacter pylori bacterium. One such test is a breath test. A patient is given a drink containing a radioactive substance that the bacterium will react with if it is present. The patient is then asked to breathe into a mechanism that determines whether the patient's breath is radioactive. If it is, that means the bacterium is present. This kind of test is important since the vast majority of people with ulcers are infected with Helicobacter pylori.