Stomach Ulcer Diagnosis: Hospital Procedures And Tests

Stomach ulcers are open sores in the stomach lining that can cause abdominal pain, nausea, and indigestion. They are typically caused by an H. pylori bacterial infection or frequent use of nonsteroidal anti-inflammatory drugs (NSAIDs). While stomach ulcers are not usually a medical emergency, they can become serious if left untreated. To diagnose a stomach ulcer, a healthcare professional will evaluate symptoms, medical history, and medications. They may then perform a physical exam, breath test, stool test, or blood test to check for H. pylori. In some cases, an endoscopy or gastroscopy may be ordered to visually inspect the stomach for ulcers.

Patient's symptoms, medical history and medications

When diagnosing a stomach ulcer, healthcare professionals will first ask about the patient's symptoms, medical history, and medications.

Patient Symptoms

Stomach ulcers can cause a range of symptoms, including:

• Burning or gnawing abdominal pain between the breastbone and belly button
• Indigestion, or burning stomach pain with a feeling of fullness
• Acid reflux and heartburn
• Nausea and vomiting
• Bloating, belching, and gas pain

However, not all stomach ulcers cause noticeable symptoms, and some people may not feel any pain at all. These are known as silent ulcers, and individuals might not experience any symptoms until the ulcer has caused complications, such as bleeding or a perforation (a hole in the stomach wall).

Medical History

As part of the diagnosis, the doctor will ask about the patient's medical history. This is important because certain factors can increase the risk of developing stomach ulcers. For example, a history of frequent use of non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin is a common cause of stomach ulcers. Additionally, a history of bacterial infection with Helicobacter pylori (H. pylori) is another leading cause of stomach ulcers.

Medications

Information about the patient's current medications is crucial in diagnosing a stomach ulcer. This includes understanding whether the patient is taking any over-the-counter (OTC) pain medications or proton pump inhibitors (PPIs). Additionally, if the patient is taking antibiotics, this could indicate a previous or current H. pylori infection, which is relevant to the diagnosis and treatment plan.

Physical examination

To diagnose a stomach ulcer, a doctor will first ask about your symptoms, medical history, and medications. They will then conduct a physical examination.

During the physical examination, the doctor will look for signs of a stomach ulcer, which typically include burning stomach pain and indigestion. The pain may feel like an acid burn in the stomach or abdomen, between the breastbone and belly button, a little to the left. Many people also experience indigestion, acid reflux, heartburn, nausea, vomiting, bloating, belching, and gas pain.

The doctor may also palpate the abdomen to check for any tenderness or masses. They may listen to your bowel sounds with a stethoscope to assess for any abnormalities. A physical examination is crucial in ruling out other potential causes of your symptoms, such as food poisoning, appendicitis, gall bladder issues, or intestinal inflammation.

If the doctor suspects a stomach ulcer, they may refer you for further tests, such as a breath, stool, or blood test to check for an H. pylori bacterial infection, a common cause of stomach ulcers. They may also recommend an endoscopy or gastroscopy, where a thin tube with a camera is inserted down your throat to visually examine your stomach for ulcers and take tissue samples if needed.

Blood, stool or breath test for H. pylori infection

If a doctor suspects you have a stomach ulcer, they will first ask about your symptoms, medical history, and any medications you are taking. They may then order a blood, stool, or breath test to check for a Helicobacter pylori (H. pylori) infection, which is the cause of most stomach ulcers.

Blood test

A blood test is used to detect antibodies to the H. pylori bacteria. Antibodies are proteins produced naturally by the body to fight infection. This test is more commonly used in populations where the bacteria are more widespread, such as in Africa, South America, and western Asia.

Stool test

A stool test is used to detect proteins (antigens) associated with H. pylori infection in the stool. This is the most common type of stool test. There is also a stool PCR test, which can detect H. pylori infection and identify mutations that may be resistant to antibiotics.

Breath test

A breath test is the most common test for H. pylori. It involves measuring the amount of carbon dioxide in your breath after drinking a solution containing urea, a chemical that is broken down by H. pylori. Excess carbon dioxide in the breath is a sign of an H. pylori infection.

Upper endoscopy

An upper endoscopy is the most accurate test for H. pylori, but it is also invasive. It involves inserting a thin scope with a camera down your throat and into your stomach to take a tissue sample, which is then tested for H. pylori.

Endoscopy or gastroscopy

If a doctor suspects that you have a stomach ulcer, they may recommend an endoscopy or gastroscopy to confirm the diagnosis. This is a minimally invasive procedure that involves inserting a thin, flexible tube with a camera at the end (an endoscope) through your mouth and down your throat into your stomach. The camera allows the doctor to visualize your stomach and check for the presence of ulcers. The endoscope also has a light and special tools at the end, including one that allows the doctor to take a small tissue sample (biopsy) to test for the H. pylori bacteria, which is a common cause of stomach ulcers, or for stomach cancer.

Before the procedure, you will be given a mild sedative through an intravenous line to help you relax, and your throat may be numbed with a spray or gargle to prevent gagging. During the procedure, you will lie on your side while the doctor inserts the endoscope. After the procedure, you will be moved to a recovery room to rest for about 1-2 hours until the sedative wears off, and then you will typically rest at home for the remainder of the day.

Gastroscopy is typically carried out in a hospital setting, usually on the same day, so you won't need to stay overnight. Endoscopy can be performed in an outpatient setting or at a hospital, depending on the healthcare provider.

Treatment with prescription medication and diet changes

Stomach ulcers, also known as peptic ulcers, are sores in the small intestine lining or the stomach. They are usually caused by an infection with the Helicobacter pylori (H. pylori) bacteria or frequent use of non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin.

Treatment for stomach ulcers will depend on the underlying cause. If the ulcer is caused by an H. pylori infection, a course of antibiotics is typically prescribed to clear the infection, along with a proton pump inhibitor (PPI) to reduce stomach acid and protect the ulcer from damage, allowing it to heal. If the ulcer is caused by the use of NSAIDs, a course of PPI medication or an alternative type of medication known as H2-receptor antagonists may be recommended.

In addition to prescription medications, doctors may recommend dietary and lifestyle changes to help treat and prevent stomach ulcers. This includes avoiding NSAIDs, cutting out foods that may contribute to ulcers (such as spicy foods and alcohol), reducing stress, and stopping smoking. Antacids, which can be purchased over the counter, are also recommended to quickly neutralise stomach acid and alleviate symptoms. However, it is important to note that antacids do not kill the H. pylori bacteria and are not an effective long-term treatment for ulcers caused by the infection.

It is always best to consult a doctor for a proper diagnosis and suitable treatment plan, as they will consider the underlying cause of the ulcer, the patient's age, overall health, and any other medications they may be taking.

Frequently asked questions