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Diagnosis of Peptic Ulcers
by Rosalyn Carson-DeWitt, MD
Peptic ulcers can be diagnosed using both x-ray and endoscopic examinations. Specialized blood, breath, and stool tests are used to identify the presence of Helicobacter pylori. A rectal examination and stool guaiac test can reveal whether you have a bleeding ulcer.
Upper gastrointestinal endoscopy—A small tube with a light and camera on the end will be passed into your mouth, down your throat, and into your esophagus, stomach, and duodenum. Other instruments can be passed down through the endoscope to inspect the area, take biopsy samples, and treat any bleeding that is present.
Barium swallow —A chalky solution containing barium coats your digestive tract to highlight structures in the gastrointestinal tract. Multiple x-rays are taken before, while, and after you drink the barium.
Blood tests —Anemia is common for an untreated bleeding ulcer. Blood tests can detect anemia and the presence of H. pylori infection.
Stool tests for H. pylori —A tiny sample of stool may be obtained through a rectal examination done in your doctor’s office. The stool sample is tested for the presence of H. pylori. This test can also be used to check for response to antibiotic treatment against H. pylori.
Urea breath tests for H. pylori —A special drink, a capsule, or a pudding containing urea with carbon is taken before blowing up a balloon or breathing into a bottle of water. If your breath sample contains the carbon, it indicates the presence of H. pylori infection.
Stool guaiac —A small sample of stool may be obtained through a rectal examination, or after a bowel movement. It’s smeared onto a little card, and several drops of a chemical are dropped onto the stool sample. This can reveal whether blood is present in your stool, which can be a sign of a bleeding ulcer.
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Peptic ulcer disease. Merck Manual Professional Version website. Available at:
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Updated May 2014. Accessed January 12, 2017.
Peptic ulcers (stomach ulcers). National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: https://www.niddk.nih.gov/health-information/digestive-diseases/peptic-ulcers-stomach-ulcers/all-content. Updated November 2014. Accessed January 12, 2017.
Last reviewed December 2016 by Daus Mahnke, MD
Last Updated: 5/20/2015
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