Diagnosis of peptic ulcer disease
- Andrew H Soll, MD
Andrew H Soll, MD
- Emeritus Professor of Medicine
- University of California Los Angeles Center for Health Sciences
- Nimish B Vakil, MD, AGAF, FACP, FACG, FASGE
Nimish B Vakil, MD, AGAF, FACP, FACG, FASGE
- Clinical Professor of Medicine
- University of Wisconsin School of Medicine and Public Health
There are two major considerations in diagnosis of peptic ulcer disease (PUD): determining whether dyspeptic symptoms are due to PUD and determining the specific etiology of an ulcer discovered by endoscopy or radiography. Symptoms alone cannot reliably distinguish PUD from other causes of dyspepsia.
The diagnosis is generally established by upper endoscopy, although the need to pursue a definitive diagnosis depends upon the clinical setting. As an example, establishing a definitive diagnosis is always required in patients over the age of 55 years and in patients with gastrointestinal bleeding or other alarm symptoms (such as early satiety, dysphagia, weight loss, occult gastrointestinal bleeding, or otherwise unexplained anemia), although these alarm features have limited value in predicting an underlying malignancy . By contrast, empiric testing for H. pylori may be appropriate in young patients without alarm symptoms. (See "Approach to the adult with dyspepsia" and "Clinical manifestations of peptic ulcer disease".)
This topic review will discuss diagnostic studies in patients who may have a peptic ulcer, and provide an overall approach to the diagnosis. The treatment of PUD is presented separately. (See "Overview of the natural history and treatment of peptic ulcer disease".)
There are no established blood tests that can reliably predict the presence of PUD. However, a complete blood count and blood chemistries (including liver function tests and serum calcium levels) are generally obtained. Normal values on these tests are reassuring while abnormalities may help to guide further testing. Unexpected anemia, for example, warrants a detailed evaluation and may raise concern for an underlying malignancy. (See "Clinical features, diagnosis, and staging of gastric cancer".)
Detection of ulcer disease — Endoscopy is the most accurate diagnostic test for peptic ulcer disease (PUD). Sensitivity of endoscopy depends in part upon the location of the ulcer, the experience of the endoscopist, and the "gold" standard used. Experienced endoscopists detect about 90 percent of gastroduodenal lesions found by a second endoscopist, by radiography, or at surgery [2,3].
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- BLOOD TESTS
- Detection of ulcer disease
- Differentiation of benign gastric ulcers from cancer at endoscopy
- Follow-up endoscopy to exclude malignant GU
- BARIUM RADIOGRAPHY
- Detection of ulcer disease
- Radiographic differentiation of benign versus malignant lesions
- ENDOSCOPY VERSUS BARIUM RADIOGRAPHY
- HELICOBACTER PYLORI TESTING
- H. pylori testing with a known ulcer
- H. pylori testing for patients with upper GI symptoms before endoscopy
- DIAGNOSTIC APPROACH WITH ESTABLISHED ULCERS
- Unusual causes
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS