What is the diagnosis procedure for a peptic ulcer?
In order for the diagnosis of a peptic ulcer to be confirmed, a diagnostic imaging test is typically performed. The most commonly used imaging tests are:
- UGI (upper GI series) – GI, which stands for gastrointestinal, this is a test is a kind of X-ray where you will have to drink a chalk-like liquid that will increase the contrast shown on the X-ray. This allows for specific features to be seen easily by the doctor. Images of the oesophagus, stomach and small intestine will be created. The liquid, containing barium (this test is sometimes referred to as a barium swallow because of this), will coat the digestive tract in order for the ulcer to be made visible in the X-ray image.
- EGD (endoscopy) – This test uses a scope known as an endoscope which is a flexible and thin tube, a camera is placed at the end of the tube to allow for the doctor to get an inside view of the digestive tract. You will be given a mild sedative or may be placed under local anaesthesia if you wish, whilst the doctor will pass the endoscope down the throat, into the oesophagus, stomach and finally, the small intestine. If an ulcer is detected, a biopsy may be conducted to remove a small tissue sample to be sent for examination in the lab. This will help to determine if there is an H. Pylori infection present in the digestive tract lining.
An endoscopy is more likely to be performed on older patients, or if there are any symptoms of internal bleeding or significant recent weight loss due to a difficulty in swallowing (often from a blockage). If an ulcer is found, then the doctor may suggest a follow-up endoscopy to ensure that the ulcer has healed through treatment.
There are three different kinds of tests that are able to detect the presence of H. pylori:
- Blood tests – Blood tests are able to detect if there are any bacteria present through measuring the number of antibodies compared to the levels of bacteria present. Our immune system produces proteins known as antibodies in order to defend the body against foreign invaders, in this case the invader is H. pylori. A blood test is generally an inexpensive and routine procedure that is done at most medical offices. The down side of blood tests is that they may have a positive result in those who have already had an ulcer in the past and who have been treated accordingly. This impacts the accuracy of the results.
- UBT (Urea breath test) - A breath test is able to detect the presence of bacteria through measuring the amount of carbon dioxide in your breath once you have ingested a specialised tablet or liquid that contains urea (made up of minimally radioactive carbon and nitrogen). After this, you will need to exhale into a bag which will then be sealed. If infected, the breath sample will contain the radioactive carbon that was swallowed, now in the form of carbon dioxide, as the body will rid itself of carbon through breathing the substance out as carbon dioxide. H. pylori will break down the carbon in the stomach and thus increase the amount of carbon present in your blood and breath. A breath test is often more accurate than a blood test, particularly if blood tests are not routinely performed. This test is also sometimes used after you have been treated to ensure that the bacteria is no longer present.
- Tissue tests – Tissue tests are only used if the endoscopic biopsy was conducted and the sample tissue needed is available for analysis in order to detect H. pylori. These are done in a laboratory.