Peptic Ulcers - Diagnosis

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It should be noted that such tests are not as accurate as endoscopy, an invasive procedure, which is needed to confirm a diagnosis of H. pylori. The breath and stool tests, however, can be particularly useful after treatment to determine if patients are cured.

Managing the Test Results: Test and Treat. Depending on the results of the screening tests, some doctors take the following steps:

• Approach for Noninfected Individuals. People who do not have evidence of H. pylori on a blood test or breath are typically given a 4-week course of acid-suppressing medication, usually PPIs, such as omeprazole (Prilosec).
• Approach for H-Pylori- Infected Individuals. Patients who have evidence of bacterial infection are given antibiotics. If this does not relieve symptoms, they are given another 6-week course of omeprazole (Prilosec). (Whether to give antibiotics to infected patients with non-ulcer dyspepsia is controversial, however, and discussed in the section What Are the Guidelines for Treating Peptic Ulcers Caused by H. pylori?)

If symptoms persist, then usually panendoscopy, also know simply as endoscopy, is performed. This is an invasive procedure, but only endoscopy allows a biopsy of stomach tissue, making it the most accurate test.

Experts debate on whether endoscopy should be performed on all patients who do not respond to initial medication. It does not appear to add any useful information on treatment choices, however, unless there is evidence or suspicion of bleeding or serious complications.

Although endoscopy, an invasive test, is the gold standard for diagnosing upper GI disorders, three-dimensional CT imaging may be valuable, as well. Researchers in China recently compared the results of endoscopy to the results of noninvasive CT imaging performed to diagnose GI tract disease. They found that the CT imaging correctly diagnosed 50 of 52 cases, including 5 cases of peptic ulcer disease. Three-dimensional CT imaging clearly showed the GI tract lesions and currently is a valuable complementary technique to endoscopy. Still, endoscopy will remain the gold standard for diagnosis because it allows doctors to biopsy the stomach.